Healthcare Provider Details

I. General information

NPI: 1285835926
Provider Name (Legal Business Name): BRUCE J CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 01/04/2022
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159 STE 125
CHILLICOTHEE OH
45601-7065
US

IV. Provider business mailing address

2410 ROUND ROCK AVE STE 110
ROUND ROCK TX
78681-4019
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4570
  • Fax: 740-779-4579
Mailing address:
  • Phone: 512-814-3695
  • Fax: 512-314-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberFC2380171
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23191
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.121677
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberS0145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: