Healthcare Provider Details

I. General information

NPI: 1841302114
Provider Name (Legal Business Name): CHAN P VO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LEMAY FERRY RD SUITE #226
ST LOUIS MO
63125
US

IV. Provider business mailing address

2900 LEMAY FERRY RD SUITE #226
ST LOUIS MO
63125
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-9192
  • Fax: 314-894-3210
Mailing address:
  • Phone: 314-894-9192
  • Fax: 314-894-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number36643
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier202885208
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: