Provider Demographics
NPI:1689817843
Name:CHAVEZ, EDGARD (MD)
Entity Type:Individual
Prefix:
First Name:EDGARD
Middle Name:
Last Name:CHAVEZ
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 1:3897 PEACOCK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9516
Mailing Address - Country:US
Mailing Address - Phone:321-745-5954
Mailing Address - Fax:772-388-9067
Practice Address - Street 1:1636 N CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3808
Practice Address - Country:US
Practice Address - Phone:772-388-9066
Practice Address - Fax:772-388-9067
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine