Healthcare Provider Details

I. General information

NPI: 1487627303
Provider Name (Legal Business Name): DOUGLAS JOSEPH CHADBOURNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 ASTRONAUT BLVD
CAPE CANAVERAL FL
32920-4239
US

IV. Provider business mailing address

6348 DEARMAN ST
COCOA FL
32927-8981
US

V. Phone/Fax

Practice location:
  • Phone: 800-638-8083
  • Fax: 321-868-0378
Mailing address:
  • Phone: 850-496-7101
  • Fax: 321-868-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME89733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: