Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 18351 | WV |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 33730 | KY |
Y | 207YP0228X | Pediatric Otolaryngology | ME108101 | FL |
NPI | 1760477582 |
---|---|
Provider Name | James Brett Chafin |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 08/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100892000 | (05) | WV |
040010292 | RR MEDICARE (01) | WV |
040011865 | RR MEDICARE (01) | KY |
64941669 | (05) | KY |
G47547 | (02) |