Provider Demographics
NPI:1720408495
Name:CHEN, WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:THANG
Other - Middle Name:TIEN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2817 REILLY RD BOX 282
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7301
Mailing Address - Country:US
Mailing Address - Phone:910-907-6902
Mailing Address - Fax:910-907-7907
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-4820
Practice Address - Fax:910-450-4437
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCTR130213ES0103X
VA0103301186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCTR130OtherMILITARY, TRICARE