Provider Demographics
NPI:1639338494
Name:WAWER-CHUBB, ALLISON K (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:K
Last Name:WAWER-CHUBB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1160 SADDLE BRONC DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7045
Mailing Address - Country:US
Mailing Address - Phone:915-593-2033
Mailing Address - Fax:915-595-3916
Practice Address - Street 1:1160 SADDLE BRONC DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7045
Practice Address - Country:US
Practice Address - Phone:915-593-2033
Practice Address - Fax:915-595-3916
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014410208000000X
TXR4165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102158008Medicaid
PA210901OtherJOHNS HOPKINS
PA20077602OtherAMERIHEALTH MERCY-WMG
PA2058614OtherHIGHMARK BLUE SHIELD
PA244070OtherUNISON-WMG
PA119587OtherGEISINGER HEALTH PLAN
MD932163OtherCAREFIRST MD BCBS
PA9991184OtherAETNA
PA50078844OtherCAPITAL BLUE CROSS-WMG
PAP009310OtherGATEWAY-WMG
PA175064FLTMedicare PIN