Basic Information
| Provider Information | |||||||||
| NPI: | 1255535811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUKE | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | TAIGO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5607 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775085607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819912200 | ||||||||
| FaxNumber: | 2819917700 | ||||||||
| Practice Location | |||||||||
| Address1: | 5010 CRENSHAW RD | ||||||||
| Address2: | STE. #130 | ||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775053047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819912200 | ||||||||
| FaxNumber: | 2819917700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 02/16/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M6138 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | M6138 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | M6138 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | M6138 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.