Basic Information
| Provider Information | |||||||||
| NPI: | 1477749695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARY J. CHANG MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7156 | ||||||||
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| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952670156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094676866 | ||||||||
| FaxNumber: | 2094676865 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 CAMINO EL ESTERO | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313755151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8313755151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | G48331 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.