Provider Demographics
NPI:1427051135
Name:CHANCE, TAMARA S (DO)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:CHANCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4821
Mailing Address - Country:US
Mailing Address - Phone:515-433-8498
Mailing Address - Fax:515-433-8965
Practice Address - Street 1:320 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IA
Practice Address - Zip Code:50212-3060
Practice Address - Country:US
Practice Address - Phone:515-275-2417
Practice Address - Fax:515-275-4678
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-03013207Q00000X
IA03013207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31622OtherBCBS PROVIDER #
IA2165605Medicaid
IA546840012OtherMEDICARE PTAN
IA546830011OtherMEDICARE PTAN
IA2165605Medicaid
G72090Medicare UPIN