Provider Demographics
NPI:1902849912
Name:CHAFFIN, DONALD L JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:CHAFFIN
Suffix:JR
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:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-1311
Mailing Address - Country:US
Mailing Address - Phone:606-298-7772
Mailing Address - Fax:606-298-7564
Practice Address - Street 1:3165 BLACKLOG RD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-9113
Practice Address - Country:US
Practice Address - Phone:606-298-7772
Practice Address - Fax:606-298-7564
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64228406Medicaid
KY1402301Medicare PIN
KY64228406Medicaid