Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 271 | OR |
NPI | 1245212836 |
---|---|
Provider Name | Dr. Jacqueline Barbara Chen |
First Address | Waynesville, MO 65583-2469 |
Second Address | Northbrook, IL 60062-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 25/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01582259 | RAILROAD MEDICARE (01) | MO |