Provider Demographics
NPI:1104802685
Name:CHAMBERS, JASON T (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:109A PARK WEST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583
Mailing Address - Country:US
Mailing Address - Phone:337-262-0189
Mailing Address - Fax:337-593-9751
Practice Address - Street 1:109 A PARK WEST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70592
Practice Address - Country:US
Practice Address - Phone:337-262-0189
Practice Address - Fax:337-593-9751
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA024738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15-75046Medicaid
LA4A912Medicare ID - Type Unspecified
LAH24974Medicare UPIN