Provider Demographics
NPI:1285679456
Name:CHAMBERLIN, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:CHAMBERLIN
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 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-522-0116
Mailing Address - Fax:575-522-0094
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-522-0116
Practice Address - Fax:575-522-0094
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12784207RG0100X
NMMD2014-0875207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM403912YY54OtherMEDICARE PTAN
NM59622539Medicaid