Provider Demographics
NPI:1962493619
Name:CHENVEN, ERIC SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:CHENVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1200 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2134
Practice Address - Country:US
Practice Address - Phone:954-463-6408
Practice Address - Fax:954-463-1858
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87659208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1192963OtherWELLCARE
FL79056OtherBLUECROSS BLUESHIELD OF FL
FL000056842ZOtherHUMANA
FLP0003137OtherFLORIDA HEALTHCARE PLUS
FL6902213OtherCIGNA
FLP00731868OtherRAILROAD MEDICARE
FL2677903-00Medicaid
FL11985OtherMEDICA
FLPRL00000274253OtherPREFERRED MEDICAL PLAN (COMM/MEDICARE)
FL10201OtherDIMENSION HEALTH
FL79056YMedicare PIN
FLP0003137OtherFLORIDA HEALTHCARE PLUS
FLP00731868OtherRAILROAD MEDICARE