Provider Demographics
NPI:1316101124
Name:CHAVEZ, DORIS MARILU (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:MARILU
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:1436 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2507
Practice Address - Country:US
Practice Address - Phone:646-759-5453
Practice Address - Fax:646-374-4940
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS7405207Q00000X
NMMD2011-0563207Q00000X
AZ58349207Q00000X
OH35.140675207Q00000X
FL812207Q00000X
NY279186-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine