Provider Demographics
NPI:1225066616
Name:CHASE, CONNOR CORL (MD)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:CORL
Last Name:CHASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6056 EBONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2871
Mailing Address - Country:US
Mailing Address - Phone:210-381-2551
Mailing Address - Fax:
Practice Address - Street 1:6056 EBONWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2871
Practice Address - Country:US
Practice Address - Phone:210-381-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5080OtherMEDICAL LICENSE
TXA0107209OtherTEXAS CONTROLLED SUBSTANCES REGISTRATION CERTIFICATE
TXA0107209OtherTEXAS CONTROLLED SUBSTANCES REGISTRATION CERTIFICATE
TXG70557Medicare UPIN