Provider Demographics
NPI:1487640249
Name:CHAPLA, JERAM P (MD)
Entity Type:Individual
Prefix:
First Name:JERAM
Middle Name:P
Last Name:CHAPLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3302
Mailing Address - Country:US
Mailing Address - Phone:321-383-3332
Mailing Address - Fax:321-383-3055
Practice Address - Street 1:1027 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3302
Practice Address - Country:US
Practice Address - Phone:321-383-3332
Practice Address - Fax:321-383-3055
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-02-02
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
FLME0062680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine