Provider Demographics
NPI:1528046927
Name:CHUA, JOSEPHINE DEZA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:DEZA
Last Name:CHUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3440 NE STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-8719
Mailing Address - Country:US
Mailing Address - Phone:936-564-2710
Mailing Address - Fax:936-564-2791
Practice Address - Street 1:3440 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-8719
Practice Address - Country:US
Practice Address - Phone:936-564-2710
Practice Address - Fax:936-564-2791
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9503207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142075401Medicaid
TX752908294OtherTAX ID
TX752908294OtherTAX ID
TX8411M1Medicare ID - Type Unspecified