Organization
MARY ANN CHAVEZ DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ANN CHAVEZ DO (OWNER/PRESIDENT)
(812) 268-3901
Entity
Organization
Contact information
Practice address
222 W BEECH ST, SULLIVAN, IN 47882-1462
(812) 268-3901
(812) 268-0674
Mailing address
222 W BEECH ST, SULLIVAN, IN 47882-1462
(812) 268-3901
(812) 268-0674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002313A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200343440
—
IN
05
—
200910590A
—
IN
Enumeration date
08/21/2008
Last updated
02/09/2010
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