MEDICARE: WILLIAM B CHU

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	172A00000X	Driver

General Provider Information

NPI Number	:	1669019105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM B CHU

Provider Business Mailing Address
First Line	:	5007 FAIRWATER CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2355
Country	:	US
Telephone Number	:	912-412-0954
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 FAIRWATER CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2355
Country	:	US
Telephone Number	:	912-412-0954
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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Directions to “ WILLIAM B CHU ” Practice Location

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