Provider Demographics
NPI:1689683153
Name:CHANG, EDUARDO ENRIQUE
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ENRIQUE
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDUARDO
Other - Middle Name:ENRIQUE
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3115 COLLEGE PARK DR
Mailing Address - Street 2:STE. 110
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4000
Mailing Address - Country:US
Mailing Address - Phone:936-447-9352
Mailing Address - Fax:936-447-9354
Practice Address - Street 1:3115 COLLEGE PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4001
Practice Address - Country:US
Practice Address - Phone:936-447-9352
Practice Address - Fax:936-447-9354
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081155A207RC0200X
CAA67939207RC0200X, 207RA0201X, 207RP1001X
TXL0073207RP1001X
LAMD.022572207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679390Medicaid
G41045Medicare UPIN
CA00A679390Medicare ID - Type Unspecified