Provider Demographics
NPI:1992957039
Name:CHAN, CELIA L (MD)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:L
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 503837
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:573-331-6880
Mailing Address - Fax:573-331-6887
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:SUITE 315
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4566
Practice Address - Country:US
Practice Address - Phone:573-331-6476
Practice Address - Fax:573-331-6526
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO106745207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106745OtherMISSOURI LICENSE