Chacko, Jebin Mathew

Chacko, Jebin Mathew is an individual health care provider with primary practice located at 1701 3Rd St Se , Puyallup WA 98372-4511. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Chacko, Jebin Mathew can be contacted via phone (253) 697-4747.

Contact Information

Primary practice address
1701 3Rd St Se Puyallup WA 98372-4511
Phone: (253) 697-4747
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 242143 New York
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD60294851 Washington

Profile Details

NPI number 1598778458
LBN Legal business name Chacko, Jebin Mathew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2006
Last updated Sep 14th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598778458 NPPES
New York MEDICAID 02888195

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