Basic Information
| Provider Information | |||||||||
| NPI: | 1861467656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S DOBSON RD | ||||||||
| Address2: | STE E39 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807775888 | ||||||||
| FaxNumber: | 4807778996 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S DOBSON RD | ||||||||
| Address2: | STE E39 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807775888 | ||||||||
| FaxNumber: | 4807778996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21908 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 346967 | 05 | AZ | MEDICAID |