Provider Demographics
NPI:1689244766
Name:CHANDRA, DAVID RAJ (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAJ
Last Name:CHANDRA
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W BYRON NELSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3513
Mailing Address - Country:US
Mailing Address - Phone:817-674-7494
Mailing Address - Fax:
Practice Address - Street 1:2301 S FM 51 STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3864
Practice Address - Country:US
Practice Address - Phone:817-674-7494
Practice Address - Fax:817-674-7496
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692148213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery