Provider Demographics
NPI:1194932996
Name:CHEN, FANGXIANG (MD)
Entity type:Individual
Prefix:
First Name:FANGXIANG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:STE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-543-5999
Mailing Address - Fax:314-543-5994
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:STE 400
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-543-5999
Practice Address - Fax:314-543-5994
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-7468207T00000X
IA39180207T00000X
AZ43769207T00000X
MO2011015498207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156440052OtherMEDICARE PTAN