Provider Demographics
NPI:1649405523
Name:CHANG, EDWARD L (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:146 E HOSPITAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4170
Mailing Address - Country:US
Mailing Address - Phone:979-849-2381
Mailing Address - Fax:979-849-0665
Practice Address - Street 1:146 E HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4170
Practice Address - Country:US
Practice Address - Phone:979-849-2381
Practice Address - Fax:979-849-0665
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP3613208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299960901Medicaid