Provider Demographics
NPI:1902053556
Name:PADILLA CHACON, FERNANDO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:RAFAEL
Last Name:PADILLA CHACON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:1401 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2936
Practice Address - Country:US
Practice Address - Phone:501-320-7000
Practice Address - Fax:501-320-7001
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ5524207Q00000X
ARE-15960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine