1891060646 NPI number — JEROME ALLEN CHATOW M.D.

Table of content: JEROME ALLEN CHATOW M.D. (NPI 1891060646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891060646 NPI number — JEROME ALLEN CHATOW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHATOW
Provider First Name:
JEROME
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1891060646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35935 ROYAL SAGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM DESERT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92211-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-772-1147
Provider Business Mailing Address Fax Number:
206-203-1274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35935 ROYAL SAGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92211-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-772-1147
Provider Business Practice Location Address Fax Number:
206-203-1274
Provider Enumeration Date:
03/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  GFE9522 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)