Basic Information
Provider Information
NPI: 1609802131
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRYS
FirstName: ROYCE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2125 OAK GROVE RD
Address2: SUITE 200
City: WALNUT CREEK
State: CA
PostalCode: 945982536
CountryCode: US
TelephoneNumber: 9252967150
FaxNumber: 9252967171
Practice Location
Address1: 2125 OAK GROVE RD
Address2: SUITE 200
City: WALNUT CREEK
State: CA
PostalCode: 945982536
CountryCode: US
TelephoneNumber: 9252967150
FaxNumber: 9252967171
Other Information
ProviderEnumerationDate: 06/25/2006
LastUpdateDate: 04/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XG54994CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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