Healthcare Provider Details

I. General information

NPI: 1336688795
Provider Name (Legal Business Name): ALEXANDER K CHANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER KUAN CHONG CHANG D.O.

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102206912
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26927
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4386
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: