Healthcare Provider Details

I. General information

NPI: 1194929794
Provider Name (Legal Business Name): STEPHANIE MARIE CHANDLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 S MASON RD
KATY TX
77450-7633
US

IV. Provider business mailing address

918 MESA TERRACE DR
KATY TX
77450-3809
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-4300
  • Fax:
Mailing address:
  • Phone: 409-392-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN2981
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: