Individual
CHAZ LAMAR CLYBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5217 SHADY GROVE LN, VIRGINIA BEACH, VA 23462-1787
(757) 800-7806
Mailing address
5217 SHADY GROVE LN, VIRGINIA BEACH, VA 23462-1787
(757) 800-7806
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MEBS3R6R
AETNA
VA
Enumeration date
11/22/2019
Last updated
12/20/2019
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