Healthcare Provider Details

I. General information

NPI: 1487613691
Provider Name (Legal Business Name): LAWRENCE CHUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

3655 W ANTHEM WAY SUITE A-109; PMB 313
ANTHEM AZ
85086-0430
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-4479
  • Fax: 602-879-1876
Mailing address:
  • Phone: 602-505-4479
  • Fax: 602-879-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31669
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number31669
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: