Healthcare Provider Details

I. General information

NPI: 1699533000
Provider Name (Legal Business Name): CHHOUEN PRACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 04/23/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER, MCHE-MDX,INTERNAL MEDICINE 3551 ROGER BROOKE DR
JBSA-FORT SAM HOUSTON TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 603-504-4738
  • Fax:
Mailing address:
  • Phone: 603-504-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: