MEDICARE: DR. RONALD SCOTT CHAMBERLAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	51311	AZ
2	208600000X	Surgery Physician	ME148095	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z209179	OTHER	AZ	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063421766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD SCOTT CHAMBERLAIN M.D.

Provider Business Mailing Address
First Line	:	13933 17TH ST STE 200
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:	352-437-5972
Fax Number	:

Provider Business Practice Location Address
First Line	:	13933 17TH ST STE 200
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4604
Country	:	US
Telephone Number	:	352-437-5972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/18/2023

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Directions to “ DR. RONALD SCOTT CHAMBERLAIN M.D.” Practice Location

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