Provider Demographics
NPI:1346775566
Name:CHACON MARTINEZ, ANDRES ROBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:ROBERTO
Last Name:CHACON MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SE 14TH TER APT 2102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3420
Mailing Address - Country:US
Mailing Address - Phone:561-766-3472
Mailing Address - Fax:561-766-3472
Practice Address - Street 1:900 NW 17TH ST # 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1119
Practice Address - Country:US
Practice Address - Phone:305-243-2742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2021-06-15
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2018-05-29
Provider Licenses
StateLicense IDTaxonomies
NH21514208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1346775566Medicaid