Provider Demographics
NPI:1134106529
Name:CHAMBLISS, ROBERT BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRYAN
Last Name:CHAMBLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2583
Mailing Address - Country:US
Mailing Address - Phone:270-756-2258
Mailing Address - Fax:270-756-1239
Practice Address - Street 1:105 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2583
Practice Address - Country:US
Practice Address - Phone:270-756-2258
Practice Address - Fax:270-756-1239
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64135858Medicaid
KY1054684OtherPASSPORT
KYC69842Medicare UPIN
KY1098101Medicare ID - Type Unspecified