Provider Demographics
NPI:1770566333
Name:CHAKMAKJIAN, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHAKMAKJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7655
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-7655
Mailing Address - Country:US
Mailing Address - Phone:254-751-9669
Mailing Address - Fax:
Practice Address - Street 1:601 W STATE HIGHWAY 6
Practice Address - Street 2:SUITE 102
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5591
Practice Address - Country:US
Practice Address - Phone:254-399-8364
Practice Address - Fax:254-399-9116
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157839502Medicaid
TX850520OtherBLUE CROSS BLUE SHIELD
TX201581079OtherTRICARE
TX157839502OtherSUPERIOR CHIP
TX84506OtherSCOTT & WHITE
TX157839502Medicaid