MEDICARE: DR. BILLY MITCHELL CHANDLER SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	C-2922	AR

General Provider Information

NPI Number	:	1336309657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLY MITCHELL CHANDLER SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72115-0128
Country	:	US
Telephone Number	:	501-753-2338
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 JUSTIN MATTHEWS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8543
Country	:	US
Telephone Number	:	501-753-2338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/10/2008

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