Provider Demographics
NPI:1669430732
Name:BROOME-WEBSTER, CHAD LANGSTON (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:LANGSTON
Last Name:BROOME-WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2321
Mailing Address - Country:US
Mailing Address - Phone:386-258-8722
Mailing Address - Fax:386-258-8659
Practice Address - Street 1:938 SAXON BLVD
Practice Address - Street 2:SUITE 101 C
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8305
Practice Address - Country:US
Practice Address - Phone:386-774-5485
Practice Address - Fax:386-775-0761
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83626207UN0901X
FLME83626207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06618OtherBCBS
FL263267500Medicaid
FL06618OtherBCBS
H53064Medicare UPIN