Provider Demographics
NPI:1477691483
Name:JOSEPH L. CHATHAM, M.D. LTD
Entity Type:Organization
Organization Name:JOSEPH L. CHATHAM, M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-2010
Mailing Address - Street 1:221 S POWER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5205
Mailing Address - Country:US
Mailing Address - Phone:480-981-2010
Mailing Address - Fax:480-981-1771
Practice Address - Street 1:221 S POWER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5205
Practice Address - Country:US
Practice Address - Phone:480-981-2010
Practice Address - Fax:480-981-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF02490Medicaid
AZ74578Medicare ID - Type Unspecified
AZF02490Medicaid