Provider Demographics
NPI:1295763399
Name:CHELEBIAN, JACK (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CHELEBIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6625 WOOLDRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2916
Mailing Address - Country:US
Mailing Address - Phone:361-884-1236
Mailing Address - Fax:361-884-5331
Practice Address - Street 1:6625 WOOLDRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2916
Practice Address - Country:US
Practice Address - Phone:361-884-1236
Practice Address - Fax:361-884-5331
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN62162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10103BMedicare ID - Type Unspecified