Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | OS5728 | FL |
Y | 207RX0202X | Medical Oncology | OS5728 | FL |
NPI | 1073502233 |
---|---|
Provider Name | Kerry E Chamberlain |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Largo, FL 33770-2542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 06/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038215900 | (05) | FL |
E76167 | (02) |