Basic Information
| Provider Information | |||||||||
| NPI: | 1265629042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAIN | ||||||||
| FirstName: | PHILIPPE | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1289 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336011289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138448927 | ||||||||
| FaxNumber: | 8138444671 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 MORRISON RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335114849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444300 | ||||||||
| FaxNumber: | 8138441909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 046530 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 046530 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME122502 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 007228810 | 05 | CT | MEDICAID |