Provider Demographics
NPI:1902827801
Name:CHADWELL, SIDNEY BOYD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:BOYD
Last Name:CHADWELL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8476
Mailing Address - Country:US
Mailing Address - Phone:903-723-8533
Mailing Address - Fax:903-723-5190
Practice Address - Street 1:4201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8476
Practice Address - Country:US
Practice Address - Phone:903-723-8533
Practice Address - Fax:903-723-5190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130873602Medicaid
TX614446Medicare PIN
TX130873602Medicaid