Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 046530 | CT |
Y | 207Q00000X | Family Doctor | ME122502 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | 046530 | CT |
NPI | 1265629042 |
---|---|
Provider Name | Dr. Philippe Robert Chain |
First Address | Tampa, FL 33601-1289 |
Second Address | Brandon, FL 33511-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 13/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007228810 | (05) | CT |