Provider Demographics
NPI:1982627576
Name:CHAVES, JOHN ROGER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGER
Last Name:CHAVES
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:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-7001
Mailing Address - Country:US
Mailing Address - Phone:818-888-7815
Mailing Address - Fax:818-715-1722
Practice Address - Street 1:2601 W ALAMEDA AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4800
Practice Address - Country:US
Practice Address - Phone:818-842-9728
Practice Address - Fax:818-842-8273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG31984207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G319840Medicaid
CA00G319842OtherBLUE SHIELD
A919383Medicare UPIN
CA00G319840Medicaid