Individual
JERRY CHI CHUAN FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
283804
MA
208100000X
Physical Medicine & Rehabilitation Physician
MT202572
PA
Other
Enumeration date
06/26/2012
Last updated
06/17/2021
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