Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | SC001504L | PA |
N | 213ER0200X | Radiology | SC001504L | PA |
N | 2081S0010X | Sports Medicine | SC001504L | PA |
N | 213ES0000X | Sports Medicine | SC001504L | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC001504L | PA |
N | 213ES0131X | Foot Surgery | SC001504L | PA |
NPI | 1437128295 |
---|---|
Provider Name | Fred Don Chantiles |
First Address | York, PA 17403-1255 |
Second Address | York, PA 17403-1255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 20/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000503609 | (05) | PA |
T29294 | (02) |