Provider Demographics
NPI:1538478177
Name:TERRY C CHAMBLESS M.D.,P.A.
Entity Type:Organization
Organization Name:TERRY C CHAMBLESS M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-244-1683
Mailing Address - Street 1:7200 WYOMING SPRINGS DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4307
Mailing Address - Country:US
Mailing Address - Phone:512-244-1683
Mailing Address - Fax:512-244-2309
Practice Address - Street 1:7200 WYOMING SPRGS DR
Practice Address - Street 2:STE 1600
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4703
Practice Address - Country:US
Practice Address - Phone:512-244-3554
Practice Address - Fax:512-244-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB128041Medicare PIN
TX00GR59Medicare PIN