Provider Demographics
NPI:1770661738
Name:WAYNE S. CHRONISTER MD, INC
Entity Type:Organization
Organization Name:WAYNE S. CHRONISTER MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRONISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-871-7272
Mailing Address - Street 1:800 POLLARD RD STE A6
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1432
Mailing Address - Country:US
Mailing Address - Phone:408-871-7272
Mailing Address - Fax:408-871-7268
Practice Address - Street 1:800 POLLARD RD STE A6
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1432
Practice Address - Country:US
Practice Address - Phone:408-871-7272
Practice Address - Fax:408-871-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20539207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200019994OtherRAILROAD MEDICARE
CA00A205390Medicaid
ZZZ06520ZMedicare PIN
200019994OtherRAILROAD MEDICARE