Provider Demographics
NPI:1528348364
Name:JEAN PIERRE CHACON, PA
Entity type:Organization
Organization Name:JEAN PIERRE CHACON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-298-8489
Mailing Address - Street 1:291 N MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5027
Mailing Address - Country:US
Mailing Address - Phone:305-298-8489
Mailing Address - Fax:
Practice Address - Street 1:240 CRANDON BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1543
Practice Address - Country:US
Practice Address - Phone:305-298-8489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2322261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service