Individual
DR. DAVID ROGER CHABOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4205 BELFORT RD STE 1100, JACKSONVILLE, FL 32216-5876
(904) 450-6300
(904) 281-5966
Mailing address
3 SHIRCLIFF WAY, SUITE 724, JACKSONVILLE, FL 32204-4786
(904) 308-7959
(904) 308-7938
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME68656
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130012335
RAILROAD MEDICARE
FL
05
—
268609100
—
FL
01
—
27473
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/20/2005
Last updated
07/29/2019
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