Basic Information
Provider Information
NPI: 1881117331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAVEZ
FirstName: DAVID
MiddleName: KARL
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 687 CHESHIRE AVE
Address2:  
City: EUGENE
State: OR
PostalCode: 974025060
CountryCode: US
TelephoneNumber: 5416844100
FaxNumber: 5416844156
Practice Location
Address1: 1450 BIRCH AVE
Address2:  
City: COTTAGE GROVE
State: OR
PostalCode: 974241417
CountryCode: US
TelephoneNumber: 5417679956
FaxNumber: 5417670377
Other Information
ProviderEnumerationDate: 07/17/2017
LastUpdateDate: 07/17/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175T00000X  Y    

No ID Information.


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