Provider Demographics
NPI:1164524427
Name:CHAN, PACHIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PACHIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19073 INTERSTATE 45 S
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8743
Mailing Address - Country:US
Mailing Address - Phone:936-271-2227
Mailing Address - Fax:936-271-2229
Practice Address - Street 1:19073 INTERSTATE 45 S
Practice Address - Street 2:SUITE 115
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8743
Practice Address - Country:US
Practice Address - Phone:936-271-2227
Practice Address - Fax:936-271-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1544579003Medicaid
TX0A5625Medicare PIN
TX1544579003Medicaid