MEDICARE: SAMUEL C. CHAN, D.O., P.A.

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	261QP2300X	Primary Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00128N	OTHER	TX	MEDICARE PTAN

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
3	5900480001	OTHER	TX	PTAN

General Provider Information

NPI Number	:	1881656791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL C. CHAN, D.O., P.A.

Provider Business Mailing Address
First Line	:	5787 S HAMPTON RD
Second Line	:	SUITE 300, LB 134
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	214-330-3034
Fax Number	:	214-330-3096

Provider Business Practice Location Address
First Line	:	5787 S HAMPTON RD
Second Line	:	SUITE 300, LB 134
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	214-330-3034
Fax Number	:	214-330-3096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAMUEL C. CHAN
Credential	:	D.O.
Telephone Number	:	214-330-3034

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	05/12/2011

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Directions to “SAMUEL C. CHAN, D.O., P.A. ” Practice Location

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