Provider Demographics
NPI:1700259918
Name:CHAVEZ, MARCO
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 W. 7TH PLACE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644
Mailing Address - Country:US
Mailing Address - Phone:580-339-6057
Mailing Address - Fax:580-303-7801
Practice Address - Street 1:2032 W. 7TH PLACE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644
Practice Address - Country:US
Practice Address - Phone:580-339-6057
Practice Address - Fax:580-303-7801
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist