MEDICARE: MR. EDUARDO CHAPA PA-C

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	363AM0700X	Medical Physician Assistant	PA04658	TX

General Provider Information

NPI Number	:	1790710036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDUARDO CHAPA PA-C

Provider Business Mailing Address
First Line	:	6202 OZARK TRL
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1585
Country	:	US
Telephone Number	:	713-928-9560
Fax Number	:	713-928-9561

Provider Business Practice Location Address
First Line	:	7037 CAPITOL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-4643
Country	:	US
Telephone Number	:	713-928-9560
Fax Number	:	713-928-9561

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/07/2013

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