Individual
JEEVARATNAM S CHANDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(936) 632-8832
Mailing address
310 GASLIGHT BLVD, LUFKIN, TX 75904-3133
(936) 632-8787
(936) 632-8832
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G4097
TX
207RC0000X
Cardiovascular Disease Physician
Primary
G4097
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128236002
—
TX
Enumeration date
12/15/2005
Last updated
11/14/2022
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