Provider Demographics
NPI:1952337677
Name:CHAO, STAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:H
Last Name:CHAO
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 1:2015 LA MESA DR
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-751-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0462208600000X
WAMD000456504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15625265Medicaid
NM15625265Medicaid
ID807456100Medicaid
WA8451510Medicaid
WA8941425OtherCRIME VICTIMS COMPENSATIO
IDE32735Medicare UPIN
P00336632Medicare PIN
ID000010156298OtherREGENCE BLUESHIELD
1133817OtherDMERC
WA8861727Medicare PIN
ID1133817Medicare PIN
ID76610OtherBLUE CROSS