Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD443548 | PA |
N | 207X00000X | Orthopaedic Surgeon | ME113787 | FL |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD443548 | PA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME113787 | FL |
NPI | 1114129236 |
---|---|
Provider Name | Dr. David Chan |
First Address | Venice, FL 34292 |
Second Address | Venice, FL 34292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 26/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1027535230001 | (05) | PA |