Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | Q8703 | TX |
N | 208000000X | Pediatrician | Q8703 | TX |
Y | 2080P0201X | Pediatric Allergist | Q8703 | TX |
NPI | 1265877054 |
---|---|
Provider Name | Jeffrey Mason Chambliss |
First Address | Dallas, TX 75390-9063 |
Second Address | Dallas, TX 75390-9063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 20/08/2018 |