MEDICARE: DR. JUSTIN RAY 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	207R00000X	Internal Medicine Physician	Q0616	TX
2	207K00000X	Allergy & Immunology Physician	Q0616	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

General Provider Information

NPI Number	:	1962728642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN RAY CHEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 610393
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75261-0393
Country	:	US
Telephone Number	:	903-291-6187
Fax Number	:	903-237-1810

Provider Business Practice Location Address
First Line	:	1009 N 4TH ST STE A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-4768
Country	:	US
Telephone Number	:	903-757-3808
Fax Number	:	903-757-3893

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

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	09/23/2019

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Directions to “ DR. JUSTIN RAY CHEN M.D.” Practice Location

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