Basic Information
| Provider Information | |||||||||
| NPI: | 1043282080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVEZ | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | LIGHDANO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 TRAFALGAR CT | ||||||||
| Address2: | STE 200E | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076670444 | ||||||||
| FaxNumber: | 4076674338 | ||||||||
| Practice Location | |||||||||
| Address1: | 4048 EVANS AVE | ||||||||
| Address2: | STE 303 | ||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339019322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393325344 | ||||||||
| FaxNumber: | 2393327246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME0090176 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0867335 | 01 | FL | CIGNA | OTHER | 3545845 | 01 | FL | AETNA | OTHER | P00296321 | 01 | FL | MCRR | OTHER | 43142 | 01 | FL | BSFL | OTHER | 43142A | 01 | FL | MCR | OTHER |