MEDICARE: CESAR A. CHAN JR. 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
1	207RG0100X	Gastroenterology Physician	42817	WI
2	207RG0100X	Gastroenterology Physician	ME162947	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00705300	OTHER	WI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679519797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR A. CHAN JR. M.D.

Provider Business Mailing Address
First Line	:	204 E 19TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4707
Country	:	US
Telephone Number	:	850-763-5409
Fax Number	:	850-763-4072

Provider Business Practice Location Address
First Line	:	204 E 19TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4707
Country	:	US
Telephone Number	:	850-763-5409
Fax Number	:	850-763-4072

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	03/21/2024

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