Individual
JAMES BRETT CHAFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
807 CHILDRENS WAY, NEMOURS CHILDRENS CLINIC, JACKSONVILLE, JACKSONVILLE, FL 32207-8426
(904) 697-3694
(904) 697-3927
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
18351
WV
207Y00000X
Otolaryngology Physician
33730
KY
207YP0228X
Pediatric Otolaryngology Physician
Primary
ME108101
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100892000
—
WV
01
—
040010292
RR MEDICARE
WV
01
—
040011865
RR MEDICARE
KY
05
—
64941669
—
KY
Enumeration date
09/19/2005
Last updated
09/08/2011
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