Provider Demographics
NPI:1558488718
Name:KIRK A. CHANDLER, DO PA
Entity type:Organization
Organization Name:KIRK A. CHANDLER, DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DO PA
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:915-886-4577
Mailing Address - Street 1:8001 N MESA ST
Mailing Address - Street 2:SUITE E BOX 304
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1736
Mailing Address - Country:US
Mailing Address - Phone:915-886-4577
Mailing Address - Fax:915-886-4579
Practice Address - Street 1:929 S. MAIN
Practice Address - Street 2:B
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821
Practice Address - Country:US
Practice Address - Phone:915-886-4577
Practice Address - Fax:915-886-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00691VMedicare ID - Type UnspecifiedMEDICARE GROUP