Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019026314 | IL |
NPI | 1013064864 |
---|---|
Provider Name | Dr. Jeffrey W Chandler |
First Address | Elmhurst, IL 60126-5068 |
Second Address | Elmhurst, IL 60126-5068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 14/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07050 | (02) | IL |