Provider Demographics
NPI:1578643904
Name:CHAN, ANDY S (MD)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:S
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 BROADWAY ST # 202-93
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5772
Mailing Address - Country:US
Mailing Address - Phone:713-535-3999
Mailing Address - Fax:713-758-0118
Practice Address - Street 1:8325 BROADWAY ST # 202-93
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5772
Practice Address - Country:US
Practice Address - Phone:713-535-3999
Practice Address - Fax:713-758-0118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3605208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151275801Medicaid
TX151275801Medicaid