Healthcare Provider Details

I. General information

NPI: 1164603379
Provider Name (Legal Business Name): WALTER F. CHASE, M.D.,P.A .RHEUMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE#605
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1301 W 38TH ST SUITE#605
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-6363
  • Fax: 512-451-2688
Mailing address:
  • Phone: 512-451-6363
  • Fax: 512-451-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG2344
License Number StateTX

VIII. Authorized Official

Name: DR. WALTER F. CHASE
Title or Position: OWNER/OPERATOR, SOLE SHAREHOLDER
Credential: M.D.
Phone: 512-451-6363