Provider Demographics
NPI:1982603163
Name:CHAVEZ, ALEXANDER C (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:CHAVEZ
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 986513
Mailing Address - Street 2:DEPT 200
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8310
Mailing Address - Fax:
Practice Address - Street 1:812 W HAGGARD AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9134
Practice Address - Country:US
Practice Address - Phone:336-449-4030
Practice Address - Fax:336-449-5315
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127HMMedicaid
NC89127HMMedicaid