1073950689 NPI number — DR. ANNA H CHACON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073950689 NPI number — DR. ANNA H CHACON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CHACON

Provider First Name:

ANNA

Provider Middle Name:

H

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1073950689

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/28/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

601 BRICKELL KEY DR STE 700

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MIAMI

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33131-2649

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

305-902-5733

Provider Business Mailing Address Fax Number:

305-203-4549

Provider First Line Business Practice Location Address:

601 BRICKELL KEY DR STE 700

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MIAMI

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33131-2649

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

305-902-5733

Provider Business Practice Location Address Fax Number:

305-203-4549

Provider Enumeration Date:

05/23/2013

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208D00000X , with the licence number:  ME125579 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207N00000X , with the licence number: ME127579 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 25MA11191500 . This is a "NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 33739 . This is a "NEBRASKA MEDICAL LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 42609 . This is a "ALABAMA MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 76339 . This is a "WISCONSIN MEDICAL LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
• Identifier: D0092430 . This is a "MARYLAND MEDICAL LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: MD24935 . This is a "MAINE MEDICAL LICENSE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
• Identifier: MED-PHYS-LIC-99482 . This is a "MONTANA MEDICAL LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 36157146 . This is a "ILLINOIS MEDICAL LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 89503 . This is a "GEORGIA MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: M-15901 . This is a "IDAHO MEDICAL LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
• Identifier: MD.MD.61175718 . This is a "WASHINGTON MEDICAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 12839 . This is a "SOUTH DAKOTA MEDICAL LICENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 21332 . This is a "NEVADA MEDICAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
• Identifier: 310885 . This is a "NEW YORK MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 328228 . This is a "LOUISIANA MEDICAL LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
• Identifier: 38429 . This is a "OKLAHOMA MEDICAL LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 4301505093 . This is a "MICHIGAN MEDICAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 69112 . This is a "CONNECTICUT MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: DR.0066706 . This is a "COLORADO MEDICAL LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: T2572 . This is a "TEXAS MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".