Provider Demographics
NPI:1033302617
Name:CHAN, DUFFY (PT)
Entity Type:Individual
Prefix:
First Name:DUFFY
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20403 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4976
Mailing Address - Country:US
Mailing Address - Phone:281-325-0188
Mailing Address - Fax:
Practice Address - Street 1:20403 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4976
Practice Address - Country:US
Practice Address - Phone:281-325-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist