MEDICARE: ERIC JOHN CHUDEJ MD

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
1	207Q00000X	Family Medicine Physician	N7530	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB115929	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1053620013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JOHN CHUDEJ MD

Provider Business Mailing Address
First Line	:	PO BOX 848476
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8476
Country	:	US
Telephone Number	:	800-994-0371
Fax Number	:	254-215-9722

Provider Business Practice Location Address
First Line	:	851 N LOOP 340
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-2592
Country	:	US
Telephone Number	:	254-202-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/13/2024

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