Active NPI
Manu Chacko, MD
- General Practice Physician
- Bryan, TX
National Provider Identifier
1366704041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0468
- Practice address
- 1200 Briarcrest Dr
Bryan, TX 77802-5222 - Phone
- (979) 268-0786
- NPI assigned
- Jun 8, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0468 | ZZ | Primary |
Addresses
Primary practice location
1200 Briarcrest Dr
Bryan, TX 77802-5222
Mailing address
8322 Cape Royal Dr
Cypress, TX 77433-6671
Phone (281) 704-8318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0468 | ZZ | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339113600000",
"number": "1366704041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8322 CAPE ROYAL DR",
"city": "CYPRESS",
"state": "TX",
"postal_code": "774336671",
"telephone_number": "281-704-8318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 BRIARCREST DR",
"city": "BRYAN",
"state": "TX",
"postal_code": "778025222",
"telephone_number": "979-268-0786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHACKO",
"first_name": "MANU",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-08",
"last_updated": "2012-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "ZZ",
"license": "0468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryan, TX
- Central Texas Endoscopy Center LLC (Central Texas Endoscopy Center)
- Central Texas Heart Center
- Central Texas Mental Health, LLC
- Central Texas Orthotics & Prosthetics, LP (Hanger Clinic)
- Central Texas Sports Medicine & Orthopaedics, P.a.
- Tracey Lynn Chamberlain, OTR
- April Lynn Chamberland Tremblay, PHARMD, BCPS, BCCCP
- Phyllis Clara Chang, M.D.
- Hector Osbaldo Chapa, M.D.
- Sarah Chapman, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.