Individual
JEBIN MATHEW CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 3RD ST SE, PUYALLUP, WA 98372-4511
(253) 697-4747
Mailing address
1701 3RD ST SE, PUYALLUP, WA 98372-4511
(253) 697-4747
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
242143
NY
2084N0400X
Neurology Physician
Primary
MD60294851
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02888195
—
NY
Enumeration date
08/14/2006
Last updated
09/14/2012
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