Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1122 | VI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 136163 | FL |
NPI | 1134211576 |
---|---|
Provider Name | Dr. Jeffrey M Chase |
First Address | St Thomas, VI 00801 |
Second Address | St Thomas, VI 00802-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 12/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75671 | (02) | VI |