Provider Demographics
NPI:1487612362
Name:CHAPA, PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:CHAPA
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 1:130 COCO PLUM DR APT 401
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-4028
Mailing Address - Country:US
Mailing Address - Phone:940-704-5309
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:940-626-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142967207P00000X
TXK9750207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9184OtherBLUE CROSS BLUE SHIELD
TX090010203Medicaid
TX930123198OtherMEDICARE RR PALMETTO
TX752760686OtherTIN
TX752760686OtherTIN
TX090010203Medicaid