Provider Demographics
NPI:1619946902
Name:CHENAULT, PRICE MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:PRICE
Middle Name:MARTIN
Last Name:CHENAULT
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 1:1211 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1099
Mailing Address - Country:US
Mailing Address - Phone:360-532-3808
Mailing Address - Fax:360-533-4884
Practice Address - Street 1:1211 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1099
Practice Address - Country:US
Practice Address - Phone:360-532-3808
Practice Address - Fax:360-533-4884
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1795707Medicaid
WA1795707Medicaid
113137502Medicare ID - Type Unspecified