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General NPI Number Information
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NPI Number | 1518595388
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Entity Type | Individual
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Provider Name | ETHAN CHANDLER MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 612 E BAILEY BOSWELL RD STE 200
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City | SAGINAW
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State | TX
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Zip | 76131-3572
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Country | US
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Telephone | 817-232-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 401 SAGE MEADOW DR
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City | AMARILLO
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State | TX
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Zip | 79124-1423
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Country | US
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Telephone | 806-676-1178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | U3181
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License Number State | TX
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