Healthcare Provider Details

I. General information

NPI: 1649405523
Provider Name (Legal Business Name): EDWARD L CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR STE 105
ANGLETON TX
77515-4170
US

IV. Provider business mailing address

146 E HOSPITAL DR STE 105
ANGLETON TX
77515-4170
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-2381
  • Fax: 979-849-0665
Mailing address:
  • Phone: 979-849-2381
  • Fax: 979-849-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP3613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: