Chaffee, Jacob Petersen

Chaffee, Jacob Petersen is an individual health care provider with primary practice located at 411 Fortuyn Rd , Grand Coulee WA 99133-8718. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Chaffee, Jacob Petersen can be contacted via phone (509) 633-1753.

Contact Information

Primary practice address
411 Fortuyn Rd Grand Coulee WA 99133-8718
Phone: (509) 633-1753
Fax: (509) 633-1933
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics 207VX0000X MD00042597 Washington
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00042597 Washington

Profile Details

NPI number 1811983562
LBN Legal business name Chaffee, Jacob Petersen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2005
Last updated Mar 14th, 2018 - about 7 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 1811983562 NPPES
Washington MEDICAID 1019674

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