Provider Demographics
NPI:1790786879
Name:AMOSSON, CHAD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MARTIN
Last Name:AMOSSON
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 1:6957 W PLANO PKWY STE 1300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1621
Mailing Address - Country:US
Mailing Address - Phone:972-820-1400
Mailing Address - Fax:972-820-1020
Practice Address - Street 1:6957 W PLANO PKWY STE 1300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1621
Practice Address - Country:US
Practice Address - Phone:972-820-1400
Practice Address - Fax:972-820-1020
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL42192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157087105Medicaid
TX157087106Medicaid
TX157087108Medicaid
TX157087103Medicaid
TX157087101Medicaid
TX109379104Medicaid
TX8L23495Medicare PIN
TXTXB122343Medicare PIN
H80124Medicare UPIN
TX157087105Medicaid
TX157087108Medicaid
TX157087101Medicaid
TX8L23446Medicare PIN
TX8A5106Medicare PIN