Provider Demographics
NPI:1083986285
Name:PEDRO S CHAVEZ-H,M.D.,P.A.
Entity Type:Organization
Organization Name:PEDRO S CHAVEZ-H,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-0269
Mailing Address - Street 1:1517 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4018
Mailing Address - Country:US
Mailing Address - Phone:915-533-0269
Mailing Address - Fax:915-542-0413
Practice Address - Street 1:1517 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4018
Practice Address - Country:US
Practice Address - Phone:915-533-0269
Practice Address - Fax:915-542-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMD7030173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097655701Medicaid
TXB21800Medicare UPIN