Provider Demographics
NPI:1144211244
Name:CHANDLER, NATHAN C (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5744 DIAMOND POINT CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4158
Mailing Address - Country:US
Mailing Address - Phone:915-569-1752
Mailing Address - Fax:
Practice Address - Street 1:5005 NORTH PIEDRAS ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY, WBAMC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 905172085R0202X
TXM92032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4112Medicare UPIN
TX8L4105Medicare UPIN