Individual
CONNIE CHAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4530 E MUIRWOOD DR, SUITE 105, PHOENIX, AZ 85048-7639
(480) 961-2303
(480) 961-0419
Mailing address
4530 E MUIRWOOD DR, SUITE 105, PHOENIX, AZ 85048-7639
(480) 961-2303
(480) 961-0419
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30337
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
715302
—
AZ
01
—
AW2081
HEALTHNET
AZ
01
—
AZ0719390
BLUE CROSS AND BLUE SHIEL
AZ
Enumeration date
02/06/2006
Last updated
07/08/2007
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