Provider Demographics
NPI:1659472892
Name:CHAVES, IGNACIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:A
Last Name:CHAVES
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 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:210-277-6387
Practice Address - Street 1:3619 PAESANOS PKWY STE 212
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1255
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:210-434-1704
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6548208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK6548OtherSTATE LICENSE NUMBER
TX103117103Medicaid
TX103117103Medicaid
TX8K3031Medicare PIN
TXBC6024210OtherDEA
TX8K3031Medicare PIN