Healthcare Provider Details

I. General information

NPI: 1558488718
Provider Name (Legal Business Name): KIRK A. CHANDLER, DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 S. MAIN B
ANTHONY TX
79821
US

IV. Provider business mailing address

8001 N MESA ST SUITE E BOX 304
EL PASO TX
79932-1736
US

V. Phone/Fax

Practice location:
  • Phone: 915-886-4577
  • Fax: 915-886-4579
Mailing address:
  • Phone: 915-886-4577
  • Fax: 915-886-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3429
License Number StateTX

VIII. Authorized Official

Name: KIRK A CHANDLER
Title or Position: DO PA
Credential: D. O.
Phone: 915-886-4577