Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | K5269 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | K5269 | TX |
NPI | 1114084365 |
---|---|
Provider Name | Dr. John R Chance Iii |
First Address | Live Oak, TX 78233-3259 |
Second Address | Live Oak, TX 78233-4222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00983033 | RAILROAD MEDICARE (01) | TX |