Provider Demographics
NPI:1215226303
Name:CHEN, ELTON (DO)
Entity type:Individual
Prefix:
First Name:ELTON
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-274-8050
Mailing Address - Fax:281-275-0760
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-274-8050
Practice Address - Fax:281-275-0760
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019430390200000X
TXQ7161207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FZ841OtherBLUE CROSS BLUE SHIELD
TX8FZ841OtherBLUE CROSS BLUE SHIELD