MEDICARE: ROLF O MONTALVO CHEN M.D.

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	207Q00000X	Family Medicine Physician	M5387	TX
2	207Q00000X	Family Medicine Physician	FTL 41518	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8W2024	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1811006539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLF O MONTALVO CHEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 301173
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1173
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 W HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1313
Country	:	US
Telephone Number	:	281-407-9341
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/19/2024

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