Healthcare Provider Details

I. General information

NPI: 1821097585
Provider Name (Legal Business Name): ELIZABETH CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N GILBERT RD SUITE L
GILBERT AZ
85234-2328
US

IV. Provider business mailing address

1400 N GILBERT RD SUITE L
GILBERT AZ
85234-2328
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-7946
  • Fax: 480-633-6153
Mailing address:
  • Phone: 480-633-7946
  • Fax: 480-633-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number29582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: