Provider Demographics
NPI:1346498755
Name:CHISHOLM, CARY DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:DANIEL
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:601 W HWY 6
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5591
Mailing Address - Country:US
Mailing Address - Phone:254-752-9621
Mailing Address - Fax:254-756-2047
Practice Address - Street 1:601 W HWY 6
Practice Address - Street 2:SUITE 111
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5591
Practice Address - Country:US
Practice Address - Phone:254-752-9621
Practice Address - Fax:254-756-2047
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9829207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology