Provider Demographics
NPI:1659349512
Name:CHAN, RODRIGO C (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:C
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 1:6709 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3738
Mailing Address - Country:US
Mailing Address - Phone:480-773-2220
Mailing Address - Fax:480-378-2440
Practice Address - Street 1:6709 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3738
Practice Address - Country:US
Practice Address - Phone:480-773-2220
Practice Address - Fax:480-378-2440
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29915207RC0001X, 207U00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ631508Medicaid
AZP00086778OtherRAIL ROAD MEDICARE
AZZ148420Medicare PIN
AZF16375Medicare UPIN
AZP00086778OtherRAIL ROAD MEDICARE