Provider Demographics
NPI:1942762000
Name:CHAVEZ GARCIA, BRYAN R (PA-C)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:CHAVEZ GARCIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:623-251-2884
Mailing Address - Fax:
Practice Address - Street 1:13985 W GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3626
Practice Address - Country:US
Practice Address - Phone:623-251-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7625363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty