Basic Information
| Provider Information | |||||||||
| NPI: | 1265517726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERLIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | OLIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 APALACHEE DR NE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337022766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275765813 | ||||||||
| FaxNumber: | 7278936978 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SIXTH STREET SOUTH | ||||||||
| Address2: | BAYFRONT FAMILY HEALTH CENTER | ||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278936917 | ||||||||
| FaxNumber: | 7278936978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0042586 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 046965300 | 05 | FL | MEDICAID |