Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60099687 | WA |
Y | 208600000X | Surgeon | MD60099687 | WA |
NPI | 1023099397 |
---|---|
Provider Name | Dr. Timothy V Chavis |
First Address | Newport, WA 99156-9046 |
Second Address | Newport, WA 99156-9046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11/01/1956 | (02) | VA |
2003336 | (05) | WA |