Provider Demographics
NPI:1679501399
Name:CHADBURN, JAMES LANE (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LANE
Last Name:CHADBURN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8942
Mailing Address - Country:US
Mailing Address - Phone:956-291-9000
Mailing Address - Fax:
Practice Address - Street 1:2601 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8942
Practice Address - Country:US
Practice Address - Phone:956-291-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM200003213E00000X
TNDPM0000000667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V12486Medicare UPIN
TN3354313Medicare PIN