Healthcare Provider Details

I. General information

NPI: 1679732903
Provider Name (Legal Business Name): BRAD CHEW MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MISSION BLVD
JACKSON CA
95642-2564
US

IV. Provider business mailing address

PO BOX 7156
STOCKTON CA
95267-0156
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-7500
  • Fax:
Mailing address:
  • Phone: 209-467-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG61736
License Number StateCA

VIII. Authorized Official

Name: BRAD J CHEW
Title or Position: PRESIDENT
Credential: MD
Phone: 209-223-7555