Provider Demographics
NPI:1487614459
Name:CHILES, LENORE RENEE (MD)
Entity type:Individual
Prefix:
First Name:LENORE
Middle Name:RENEE
Last Name:CHILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 EAST 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513
Mailing Address - Country:US
Mailing Address - Phone:254-778-5400
Mailing Address - Fax:254-778-5444
Practice Address - Street 1:1300 E. 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2810
Practice Address - Country:US
Practice Address - Phone:254-778-5400
Practice Address - Fax:254-778-5444
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7142207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH19939Medicare UPIN
TXTXB162142Medicare PIN
TXH19939Medicare UPIN