Provider Demographics
NPI:1316945595
Name:CHAPPEL, GARY J (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:CHAPPEL
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 1:2120 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2906
Mailing Address - Country:US
Mailing Address - Phone:863-688-2334
Mailing Address - Fax:863-567-1167
Practice Address - Street 1:2120 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2906
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:863-567-1167
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00386892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039383500Medicaid
FL039383500Medicaid
30568YMedicare ID - Type Unspecified