Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G2344 | TX |
N | 208D00000X | General Practice Physician | G2344 | TX |
NPI | 1013997758 |
---|---|
Provider Name | Walter F Chase |
First Address | Austin, TX 78705-1000 |
Second Address | Austin, TX 78705-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100712201 | (05) | TX |
C14396 | (02) | TX |