Provider Demographics
NPI:1861467656
Name:CHANG, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
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 1:600 S DOBSON RD
Mailing Address - Street 2:STE E39
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5693
Mailing Address - Country:US
Mailing Address - Phone:480-777-5888
Mailing Address - Fax:480-777-8996
Practice Address - Street 1:600 S DOBSON RD
Practice Address - Street 2:STE E39
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5678
Practice Address - Country:US
Practice Address - Phone:480-777-5888
Practice Address - Fax:480-777-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346967Medicaid
F75752Medicare UPIN
AZ346967Medicaid