Provider Demographics
NPI:1326779679
Name:CHAN, ALEC SPENCER (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEC
Middle Name:SPENCER
Last Name:CHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:912-996-7966
Mailing Address - Fax:575-838-4689
Practice Address - Street 1:FAMILY MEDICINE SOCORRO
Practice Address - Street 2:1202 HIGHWAY 60 BLDG D
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3914
Practice Address - Country:US
Practice Address - Phone:575-838-4690
Practice Address - Fax:575-838-4689
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2025-0001363A00000X
GA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant