Provider Demographics
NPI:1275928483
Name:CHAVEZ, CRYSTAL HAYDEE (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:HAYDEE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:HAYDEE
Other - Last Name:BENCOMO ZAVALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25723 OLD FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-6605
Mailing Address - Country:US
Mailing Address - Phone:210-450-6800
Mailing Address - Fax:210-450-6801
Practice Address - Street 1:25723 OLD FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-6605
Practice Address - Country:US
Practice Address - Phone:210-450-6800
Practice Address - Fax:210-450-6801
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389826401Medicaid
TX389826402OtherCSHCN