Provider Demographics
NPI:1689985392
Name:AGNEW, CHAD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:THOMAS
Last Name:AGNEW
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:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65615-1308
Mailing Address - Country:US
Mailing Address - Phone:417-239-3392
Mailing Address - Fax:
Practice Address - Street 1:251 SKAGGS RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2031
Practice Address - Country:US
Practice Address - Phone:417-239-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018771207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology