Provider Demographics
NPI:1689668618
Name:CHICA, GERARDO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:ANTONIO
Last Name:CHICA
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 1:1120 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6224
Mailing Address - Country:US
Mailing Address - Phone:409-727-0794
Mailing Address - Fax:409-727-6030
Practice Address - Street 1:1120 S 27TH ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6224
Practice Address - Country:US
Practice Address - Phone:409-727-0794
Practice Address - Fax:409-727-6030
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8391208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1689668618Medicare PIN
B21828Medicare UPIN