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General NPI Number Information
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NPI Number | 1710341763
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Entity Type | Individual
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Provider Name | JOHN CHANCELLOR
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Gender | Male
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1977 BUTLER BLVD FL 2
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City | HOUSTON
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State | TX
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Zip | 77030-4101
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Country | US
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Telephone | 713-798-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 523
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-5356
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | S5575
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License Number State | TX
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