Provider Demographics
NPI:1396195285
Name:CHAVEZ, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 E GREENWAY PKWY
Mailing Address - Street 2:#1115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2106
Mailing Address - Country:US
Mailing Address - Phone:773-242-8397
Mailing Address - Fax:866-211-2884
Practice Address - Street 1:6735 E GREENWAY PKWY
Practice Address - Street 2:#1115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2106
Practice Address - Country:US
Practice Address - Phone:773-242-8397
Practice Address - Fax:866-211-2884
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor