Provider Demographics
NPI:1669458246
Name:CHEN, CHUN WEN (MD)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:WEN
Last Name:CHEN
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 1:7800 US HIGHWAY 98 W
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7228
Mailing Address - Country:US
Mailing Address - Phone:850-797-2119
Mailing Address - Fax:
Practice Address - Street 1:7800 US HIGHWAY 98 W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7228
Practice Address - Country:US
Practice Address - Phone:850-278-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1046892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001359200Medicaid
FL150ZFOtherBCBS
FLCN077VOtherMEDICARE PTAN
FLCN077WOtherMEDICARE PTAN
FLCN077XOtherMEDICARE PTAN
FLP01667379OtherRAILROAD MEDICARE
FLCN077VOtherMEDICARE PTAN