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NPI Code Detail

MEDICARE: DR. RAFAEL COMACHO CHAN M.D.

MEDICARE: DR. RAFAEL COMACHO CHAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianE2169TX
22085R0202XDiagnostic Radiology PhysicianE2169TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28S3354OTHERTXBLUE CROSS OF TEXAS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033151287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAFAEL COMACHO CHAN M.D.
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1230
Country : US
Telephone Number : 972-997-8000
Fax Number : 972-467-9605
Provider Business Practice Location Address
First Line : 1450 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4110
Country : US
Telephone Number : 817-923-4423
Fax Number : 817-923-3176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/25/2008

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