Provider Demographics
NPI:1659373579
Name:CHANG, JANICE R (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:R
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:ROLLEFSON
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4127
Mailing Address - Country:US
Mailing Address - Phone:281-332-8571
Mailing Address - Fax:281-332-8307
Practice Address - Street 1:12 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-332-8571
Practice Address - Fax:281-332-8307
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9477207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK2746OtherMEDICARE RR
TX81341XOtherBCBS OF TEXAS
TX81341XOtherBCBS OF TEXAS
CK2746OtherMEDICARE RR
TX82691NMedicare PIN