Provider Demographics
NPI:1356333025
Name:CHASE, CHAD (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CHASE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:STE 205-N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4376
Practice Address - Street 1:103 MAX STARCKE DAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-798-2082
Practice Address - Fax:830-693-0040
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01729207RC0000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX970017497OtherRAILROAD MEDICARE
TX89N253OtherBC/BS
TX87N136Medicare PIN
S12083Medicare UPIN
TX87N136Medicare ID - Type Unspecified