Provider Demographics
NPI:1720358591
Name:SANCHEZ, CHAD ALFRED (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ALFRED
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 S HULEN ST STE 425
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4908
Mailing Address - Country:US
Mailing Address - Phone:817-731-2875
Mailing Address - Fax:
Practice Address - Street 1:4200 S HULEN ST STE 425
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4908
Practice Address - Country:US
Practice Address - Phone:817-731-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737101367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered