MEDICARE: NORMAN CHAMBERLAIN, P.A

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	122300000X	Dentist	DN3300	FL

General Provider Information

NPI Number	:	1821464868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMAN CHAMBERLAIN, P.A

Provider Business Mailing Address
First Line	:	305 E UNION ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2748
Country	:	US
Telephone Number	:	904-503-8393
Fax Number	:	904-503-2915

Provider Business Practice Location Address
First Line	:	305 E UNION ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2748
Country	:	US
Telephone Number	:	904-503-8393
Fax Number	:	904-503-2915

Authorized Official
Title or Position	:	DENTIST
Name	:	MR. NORMAN E CHAMBERLAIN
Credential	:	DDS
Telephone Number	:	904-503-8393

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	08/13/2015

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