Provider Demographics
NPI:1427509066
Name:CHACON, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CHACON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 WEST GULF BANK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040
Mailing Address - Country:US
Mailing Address - Phone:281-970-5900
Mailing Address - Fax:281-970-5913
Practice Address - Street 1:9777 WEST GULF BANK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040
Practice Address - Country:US
Practice Address - Phone:281-970-5900
Practice Address - Fax:281-970-5913
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic