Provider Demographics
NPI:1922257096
Name:CHAVEZ JO INTERNAL MEDICINE P.A.
Entity Type:Organization
Organization Name:CHAVEZ JO INTERNAL MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIUSCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-388-9066
Mailing Address - Street 1:1636 N CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3808
Mailing Address - Country:US
Mailing Address - Phone:772-388-9066
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty