Provider Demographics
NPI:1063421766
Name:CHAMBERLAIN, RONALD SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SCOTT
Last Name:CHAMBERLAIN
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 1:13933 17TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4604
Mailing Address - Country:US
Mailing Address - Phone:352-437-5972
Mailing Address - Fax:
Practice Address - Street 1:13933 17TH ST STE 200
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4604
Practice Address - Country:US
Practice Address - Phone:352-437-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ513112086X0206X
FLME148095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ209179OtherMEDICARE
AZ171481Medicaid
087953TUAMedicare ID - Type Unspecified