Provider Demographics
NPI:1265629042
Name:CHAIN, PHILIPPE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:ROBERT
Last Name:CHAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-8927
Mailing Address - Fax:813-844-4671
Practice Address - Street 1:214 MORRISON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4849
Practice Address - Country:US
Practice Address - Phone:813-844-4300
Practice Address - Fax:813-844-1909
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046530207QS0010X, 207Q00000X
FLME122502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007228810Medicaid