Provider Demographics
NPI:1891792941
Name:CHAN, ROSCOE HO-KEUNG (MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:ROSCOE
Middle Name:HO-KEUNG
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N CRAYCROFT RD STE 221
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2268
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:520-519-5175
Practice Address - Street 1:1100 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1690
Practice Address - Country:US
Practice Address - Phone:928-776-1040
Practice Address - Fax:928-776-1041
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI143702085R0001X
TXK72592085R0001X
PAMD-054897-L2085R0001X
KS04-261682085R0001X
LA14269R2085R0001X
GUM-15412085R0001X
ARE-137442085R0001X, 2085R0001X
AZ377852085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00370697OtherMEDICARE RAILROAD
LA10670Medicaid
AR183733001Medicaid
AZ350534OtherAPIPA- THRU UNITED HEALTHCARE
LA5261570OtherAETNA
AZ350534Medicaid
LA4785874004OtherCIGNA
TXPO83990R9Medicaid
LAP-11077417OtherMULTIPLAN
AR183733001Medicaid
LA10670Medicaid
LA4A658Medicare PIN
AZZ123404Medicare PIN
AZZ123405Medicare PIN