Provider Demographics
NPI:1831188572
Name:CHAMBLESS, TERRY C (MD,PA)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:C
Last Name:CHAMBLESS
Suffix:
Gender:M
Credentials:MD,PA
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Mailing Address - Street 1:7200 WYOMING SPRINGS DR STE 1100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4307
Mailing Address - Country:US
Mailing Address - Phone:512-244-1683
Mailing Address - Fax:512-244-2309
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE. 1600
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-1683
Practice Address - Fax:512-244-2309
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2022-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG3223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21772Medicare UPIN