Provider Demographics
NPI:1790905214
Name:CHAMBERLAIN, JEFFERY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:LEE
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:2373 64TH ST SW
Practice Address - Street 2:SUITE 1300
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-7974
Practice Address - Country:US
Practice Address - Phone:616-685-1350
Practice Address - Fax:616-261-7191
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine