Individual
DR. RAFAEL COMACHO CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1450 8TH AVE, FORT WORTH, TX 76104-4110
(817) 923-4423
(817) 923-3176
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 467-9605
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
E2169
TX
2085R0202X
Diagnostic Radiology Physician
Primary
E2169
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132672009
—
TX
05
—
132672010
—
TX
01
—
8S3354
BLUE CROSS OF TEXAS
TX
Enumeration date
06/12/2006
Last updated
04/25/2008
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