Provider Demographics
NPI:1295081479
Name:TERAN CHAVEZ, DAVID (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TERAN CHAVEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 ROCKY POINT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-2262
Mailing Address - Country:US
Mailing Address - Phone:817-291-9302
Mailing Address - Fax:
Practice Address - Street 1:2900 DENTON HWY STE A
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-3763
Practice Address - Country:US
Practice Address - Phone:817-831-2012
Practice Address - Fax:817-831-0134
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA07817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308878301Medicaid
TX333954YKN5Medicare PIN
TXTXB160155Medicare PIN