Provider Demographics
NPI:1063935286
Name:CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY
Entity type:Organization
Organization Name:CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESNUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-640-1488
Mailing Address - Street 1:510 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1332
Mailing Address - Country:US
Mailing Address - Phone:208-640-1488
Mailing Address - Fax:
Practice Address - Street 1:510 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1332
Practice Address - Country:US
Practice Address - Phone:208-640-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty