Provider Demographics
NPI:1114084365
Name:CHANCE III, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:CHANCE III
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3259
Mailing Address - Country:US
Mailing Address - Phone:210-477-5151
Mailing Address - Fax:210-477-5152
Practice Address - Street 1:6704 RANDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4222
Practice Address - Country:US
Practice Address - Phone:210-477-5151
Practice Address - Fax:210-477-5152
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK5269207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00983033OtherRAILROAD MEDICARE
TXP00983033OtherRAILROAD MEDICARE
6327600001Medicare NSC