Provider Demographics
NPI:1598824906
Name:CHAVEZ, MAURICIO RENAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:RENAN
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2753
Mailing Address - Country:US
Mailing Address - Phone:360-823-2012
Mailing Address - Fax:360-823-2260
Practice Address - Street 1:3200 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2753
Practice Address - Country:US
Practice Address - Phone:360-823-2012
Practice Address - Fax:360-823-2260
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-046325207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology