Provider Demographics
NPI:1104084029
Name:CHAVEZ, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5170 E GLENN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-7301
Mailing Address - Country:US
Mailing Address - Phone:520-355-5111
Mailing Address - Fax:520-844-6901
Practice Address - Street 1:5170 E GLENN ST STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-7301
Practice Address - Country:US
Practice Address - Phone:520-355-5111
Practice Address - Fax:520-844-6901
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2024-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ43767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ606467Medicaid
AZ606467Medicaid