Individual
JOHN CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2140 SMITH ST, ORANGE PARK, FL 32073-5554
(904) 269-2140
(904) 264-3018
Mailing address
PO BOX 45443, SALT LAKE CITY, UT 84145-0443
(904) 202-1032
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101246006
VA
208000000X
Pediatrics Physician
Primary
ME 123976
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016263600
—
FL
Enumeration date
06/18/2008
Last updated
12/24/2018
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