Provider Demographics
NPI:1003878885
Name:CHAPMAN, PHILLIP HOWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:HOWARD
Last Name:CHAPMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 POST OAK TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5967
Mailing Address - Country:US
Mailing Address - Phone:817-455-0296
Mailing Address - Fax:
Practice Address - Street 1:5605 N MACARTHUR BLVD
Practice Address - Street 2:STE. 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2617
Practice Address - Country:US
Practice Address - Phone:972-714-0007
Practice Address - Fax:972-714-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504234367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119936606Medicaid
TX119936606Medicaid