Provider Demographics
NPI:1770746190
Name:CHIN-LUE, ROLAND L (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:L
Last Name:CHIN-LUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:4211 VAN DYKE RD
Practice Address - Street 2:#200
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-264-6490
Practice Address - Fax:813-443-8143
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101582207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001214900Medicaid
FL001214900Medicaid