Provider Demographics
NPI:1972973485
Name:CHAMBERS, THOMAS EUGENE SR (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:CHAMBERS
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 QUIET FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-9176
Mailing Address - Country:US
Mailing Address - Phone:407-399-7014
Mailing Address - Fax:
Practice Address - Street 1:1800 QUIET FOREST TRL
Practice Address - Street 2:
Practice Address - City:CHULUOTA
Practice Address - State:FL
Practice Address - Zip Code:32766-9176
Practice Address - Country:US
Practice Address - Phone:407-399-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 1530208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice