Provider Demographics
NPI:1386758993
Name:CHAVEZ, HARRY L (MD)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:L
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 HOSPITAL BLVD
Mailing Address - Street 2:P.O. BOX 40
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114
Mailing Address - Country:US
Mailing Address - Phone:830-393-3114
Mailing Address - Fax:830-216-2832
Practice Address - Street 1:1303 HOSPITAL BLVD.
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114
Practice Address - Country:US
Practice Address - Phone:830-393-3114
Practice Address - Fax:830-216-2832
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126292501Medicaid
TX1262925-01Medicaid
TX126292504OtherMEDICAID HEALTH STEPS NO