Provider Demographics
NPI:1659412245
Name:CHAMBERS, JEFFREY ROY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROY
Last Name:CHAMBERS
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 1:4905 HARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8103
Mailing Address - Country:US
Mailing Address - Phone:919-452-2917
Mailing Address - Fax:919-490-3099
Practice Address - Street 1:4905 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8103
Practice Address - Country:US
Practice Address - Phone:919-452-2917
Practice Address - Fax:919-490-3099
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC317862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921899Medicaid
NC2139858AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
NC8921899Medicaid