Provider Demographics
NPI:1558546150
Name:CHAM, ROXANA ERIN (MD)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:ERIN
Last Name:CHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE #206A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:469-204-6973
Mailing Address - Fax:469-204-6976
Practice Address - Street 1:4430 LAVON DR
Practice Address - Street 2:SUITE #350
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3000
Practice Address - Country:US
Practice Address - Phone:972-530-8590
Practice Address - Fax:972-530-8625
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196939602Medicaid
TX196939601Medicaid
TX196939603Medicaid
TX196939601Medicaid
TX378257YK5BMedicare PIN
TX196939602Medicaid
TX378257YKQJMedicare PIN