Provider Demographics
NPI:1316963150
Name:CHAMBLEE, BRIAN BENNETT (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:BENNETT
Last Name:CHAMBLEE
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:P O B 840853 SUITE 212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4536
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:102B OMNI DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9448
Practice Address - Country:US
Practice Address - Phone:864-885-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51353207L00000X
TXT2136207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000095575OtherBLUE CROSS OF MONTANA
MT134310888OtherALLEGIANCE BENEFIT PLAN
MT1343108880000OtherCHAMPUS
MT134310888OtherNEW WEST & HLTH CONNECT
MT0148801Medicaid
MT000085035Medicare ID - Type Unspecified