Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | J4037 | TX |
Y | 207QA0401X | Family Doctor - Addiction Medicine | J4037 | TX |
NPI | 1902871221 |
---|---|
Provider Name | Andre S. Chen |
First Address | Round Rock, TX 78664-7580 |
Second Address | Round Rock, TX 78664-7580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102427501 | (05) | TX |
102427503 | (05) | TX |
F92550 | (02) | TX |