Provider Demographics
NPI:1205920675
Name:CHAN, BENJAMIN Q (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:Q
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:888-987-1151
Mailing Address - Fax:
Practice Address - Street 1:4900 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2737
Practice Address - Country:US
Practice Address - Phone:725-269-3368
Practice Address - Fax:725-392-5350
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000157207Q00000X
NV16230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB5069Medicaid
NV1205920675Medicaid
NV16230OtherSTATE LICENSE
NMB5069Medicaid