Provider Demographics
NPI:1578593810
Name:DAVIS, CHANSEYA A (MD)
Entity Type:Individual
Prefix:
First Name:CHANSEYA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:3370 S TEXAS AVE
Practice Address - Street 2:#B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3127
Practice Address - Country:US
Practice Address - Phone:979-595-1700
Practice Address - Fax:979-595-1740
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM1748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00452866OtherMEDICARE RAILROAD
TX184074602Medicaid
TX8AR402OtherBLUE CROSS BLUE SHIELD
TX8K1001Medicare PIN
TXI61126Medicare UPIN