Provider Demographics
NPI:1790851525
Name:CHANG, BAOCHONG B (MD)
Entity Type:Individual
Prefix:DR
First Name:BAOCHONG
Middle Name:B
Last Name:CHANG
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 1:3420 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3130
Mailing Address - Country:US
Mailing Address - Phone:254-752-2900
Mailing Address - Fax:
Practice Address - Street 1:3420 PINE AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3130
Practice Address - Country:US
Practice Address - Phone:254-752-2900
Practice Address - Fax:254-752-2902
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8302207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1645061Medicaid
TX1645061Medicaid
TX8F1334Medicare ID - Type Unspecified
TXH42193Medicare UPIN
TXTXB120080Medicare PIN