Provider Demographics
NPI:1043233810
Name:CHAN, WAYNE FAI (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:FAI
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:51 NORTHTOWN DR
Mailing Address - Street 2:19E
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3600
Mailing Address - Country:US
Mailing Address - Phone:610-362-4471
Mailing Address - Fax:601-364-1588
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:RADIATION THERAPY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA602762085R0001X
MS181042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology