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General NPI Number Information
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NPI Number | 1720127657
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Entity Type | Individual
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Provider Name | HOLLIS RICARDO CHAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15038 SW 35TH ST
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City | DAVIE
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State | FL
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Zip | 33331-2729
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Country | US
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Telephone | 954-474-5080
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Fax | 954-577-5671
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Provider Business Mailing Address
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Address Line | 15038 SW 35TH ST
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City | DAVIE
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State | FL
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Zip | 33331-2729
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Country | US
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Telephone | 954-474-5080
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Fax | 954-577-5671
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME 85971
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License Number State | FL
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