Provider Demographics
NPI:1598764821
Name:CHUANG, ALEX T (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:T
Last Name:CHUANG
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 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0312
Mailing Address - Fax:817-317-7033
Practice Address - Street 1:815 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-321-0312
Practice Address - Fax:817-317-7033
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL12942085R0202X, 2085B0100X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1660177-06Medicaid
TXI09615Medicare UPIN
TX8D6342Medicare ID - Type Unspecified'OTHER' COUNTIES
TXTXB120738Medicare PIN
TX8D6341Medicare ID - Type UnspecifiedDALLAS COUNTY