Basic Information
| Provider Information | |||||||||
| NPI: | 1629244611 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUENTIN CHAN, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1847 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852991847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
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| Practice Location | |||||||||
| Address1: | 475 S DOBSON RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHAN | ||||||||
| AuthorizedOfficialFirstName: | QUENTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4805072961 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35042 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.