Provider Demographics
NPI:1902813157
Name:CHAVEZ, ERIC M (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:770 WASHINGTON ST STE 200
Mailing Address - Street 2:ARTEMIS MEDICAL GROUP
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2209
Mailing Address - Country:US
Mailing Address - Phone:858-278-3636
Mailing Address - Fax:858-278-3637
Practice Address - Street 1:770 WASHINGTON ST STE 200
Practice Address - Street 2:ARTEMIS MEDICAL GROUP
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2209
Practice Address - Country:US
Practice Address - Phone:858-278-3636
Practice Address - Fax:858-278-3637
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0570562084P0800X
CAA674122084P0800X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674120Medicaid
H58091Medicare UPIN