Provider Demographics
NPI:1487627303
Name:CHADBOURNE, DOUGLAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:CHADBOURNE
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 1:6348 DEARMAN ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8981
Mailing Address - Country:US
Mailing Address - Phone:850-496-7101
Mailing Address - Fax:321-868-0378
Practice Address - Street 1:8810 ASTRONAUT BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-4239
Practice Address - Country:US
Practice Address - Phone:800-638-8083
Practice Address - Fax:321-868-0378
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME897332083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine