Healthcare Provider Details

I. General information

NPI: 1033790761
Provider Name (Legal Business Name): AMANDA CHAU DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CONROE MEDICAL DR
CONROE TX
77304-4722
US

IV. Provider business mailing address

605 S CONROE MEDICAL DR
CONROE TX
77304-4722
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4004
  • Fax: 936-521-3964
Mailing address:
  • Phone: 936-539-4004
  • Fax: 936-539-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10074824
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU7654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: