Basic Information
| Provider Information | |||||||||
| NPI: | 1285951194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERLAIN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF FLORIDA DEPARTMENT OF CHFM | ||||||||
| Address2: | 625 SW 4TH AVE. | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523924541 | ||||||||
| FaxNumber: | 3523927766 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF FLORIDA DEPARTMENT OF CHFM | ||||||||
| Address2: | 625 SW 4TH AVE. | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523924541 | ||||||||
| FaxNumber: | 3523927766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2010 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14709 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14709 | 01 | FL | TRAINING LICENSE | OTHER |