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Organization
J SCOTT CHENNAULT, D.O.
Active
Organization
J SCOTT CHENNAULT, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN SCOTT CHENNAULT D.O. (PHYSICIAN)
(979) 567-7080
Entity
Organization
Contact information
Practice address
1103 WOODSON DR, CALDWELL, TX 77836-1052
(979) 567-7080
Mailing address
PO BOX 1154, CALDWELL, TX 77836-6154
(979) 567-7080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00D79E
BLUE CROSS BLUE SHIELD TX
TX
01
—
113320
CHIP
TX
Enumeration date
02/05/2007
Last updated
08/22/2020
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