Provider Demographics
NPI:1780615690
Name:CHASE, EARL ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:ROBERT
Last Name:CHASE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SANDALWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-3707
Mailing Address - Country:US
Mailing Address - Phone:806-364-4266
Mailing Address - Fax:
Practice Address - Street 1:801 E 3RD ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-5727
Practice Address - Country:US
Practice Address - Phone:806-349-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079GGOtherBCBS TEXAS
TX141117506Medicaid
TXH27766Medicare UPIN
TX141117506Medicaid