Basic Information
| Provider Information | |||||||||
| NPI: | 1841363223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEBALLOS CHAVEZ | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CARLOS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 SAINT JOHNS BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514711166 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 SAINT JOHNS BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551091183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514711166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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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 | 207R00000X | 49407-020 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 57358 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.