Provider Demographics
NPI:1558365049
Name:CHAMBERS, DEBORAH J (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14606 SW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-5804
Mailing Address - Country:US
Mailing Address - Phone:843-473-3311
Mailing Address - Fax:843-706-3350
Practice Address - Street 1:57 LAKE LINDEN LN
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6423
Practice Address - Country:US
Practice Address - Phone:843-683-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74480207Q00000X
SC34703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007371735Medicaid
PA001478806OtherBS OF PA
SC347039Medicaid
PA001478806OtherBS OF PA
SC347039Medicaid
G71752Medicare UPIN