Provider Demographics
NPI:1508411505
Name:CHEN, JOHN ARTHUR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 BURGE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-1537
Mailing Address - Country:US
Mailing Address - Phone:915-539-9336
Mailing Address - Fax:
Practice Address - Street 1:BENNETT CLINIC BUILDING 420A
Practice Address - Street 2:31'ST STREET AND BATTALION AVE.
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76654
Practice Address - Country:US
Practice Address - Phone:915-539-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1164986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant