Provider Demographics
NPI:1356480826
Name:KORNEGAY, CHASE RYAN (MD)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:RYAN
Last Name:KORNEGAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 LAKESIDE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4351
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:4100 INTERNATIONAL PLZ
Practice Address - Street 2:SUITE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4820
Practice Address - Country:US
Practice Address - Phone:817-334-0530
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK24482207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200243250AMedicaid
OK200243250AMedicaid