Provider Demographics
NPI:1265877054
Name:CHAMBLISS, JEFFREY MASON (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MASON
Last Name:CHAMBLISS
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9063
Mailing Address - Country:US
Mailing Address - Phone:214-456-2084
Mailing Address - Fax:214-456-8317
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9063
Practice Address - Country:US
Practice Address - Phone:214-456-2084
Practice Address - Fax:214-456-8317
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8703207RA0201X, 208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics