Provider Demographics
NPI:1821139676
Name:SOCORRO A. CHAMBLEE, MD, PA
Entity Type:Organization
Organization Name:SOCORRO A. CHAMBLEE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOCORRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-383-5955
Mailing Address - Street 1:8080 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2901
Mailing Address - Country:US
Mailing Address - Phone:214-383-5955
Mailing Address - Fax:214-383-5966
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 120
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2901
Practice Address - Country:US
Practice Address - Phone:214-383-5955
Practice Address - Fax:214-383-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG61499Medicare UPIN
TX8A9350Medicare ID - Type Unspecified