Healthcare Provider Details

I. General information

NPI: 1891792941
Provider Name (Legal Business Name): ROSCOE HO-KEUNG CHAN MD, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GAIL GARDNER WAY
PRESCOTT AZ
86305-1690
US

IV. Provider business mailing address

2625 N CRAYCROFT RD STE 221
TUCSON AZ
85712-2268
US

V. Phone/Fax

Practice location:
  • Phone: 928-776-1040
  • Fax: 928-776-1041
Mailing address:
  • Phone: 520-519-7700
  • Fax: 520-519-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number14370
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberK7259
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-054897-L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-26168
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number14269R
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberM-1541
License Number StateGU
# 7
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberE-13744
License Number StateAR
# 8
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number37785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: