Provider Demographics
NPI:1679956163
Name:CHAVEZ HERBAS, OCTAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:
Last Name:CHAVEZ HERBAS
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 1:850 W RIO SALADO PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3812
Mailing Address - Country:US
Mailing Address - Phone:480-480-8330
Mailing Address - Fax:
Practice Address - Street 1:3140 S FALKENBURG RD STE 201
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2594
Practice Address - Country:US
Practice Address - Phone:813-910-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME144059207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program