Healthcare Provider Details

I. General information

NPI: 1679276505
Provider Name (Legal Business Name): ANGLETON PEDIATRIC CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
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

PO BOX 1330
ANGLETON TX
77516-1330
US

V. Phone/Fax

Practice location:
  • Phone: 979-849-2381
  • Fax:
Mailing address:
  • Phone: 979-709-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD L CHANG
Title or Position: MANAGER
Credential: MD
Phone: 979-709-1039