Provider Demographics
NPI:1902821895
Name:VAHOVIUS, CHET J (DPM)
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:J
Last Name:VAHOVIUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2093
Mailing Address - Country:US
Mailing Address - Phone:334-393-5135
Mailing Address - Fax:334-393-7261
Practice Address - Street 1:805 E LEE ST
Practice Address - Street 2:SUITE A
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2093
Practice Address - Country:US
Practice Address - Phone:334-393-5135
Practice Address - Fax:334-393-7261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051097984OtherBCBS
AL000097984Medicaid
AL000097984Medicaid
AL051097984OtherBCBS
AL1300130003Medicare NSC