Provider Demographics
NPI:1326184789
Name:CHAMBERS, WILLIAM MELVIN JR (DO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MELVIN
Last Name:CHAMBERS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:216 PARK PL
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3230
Mailing Address - Country:US
Mailing Address - Phone:817-270-3627
Mailing Address - Fax:817-270-5934
Practice Address - Street 1:216 PARK PL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3230
Practice Address - Country:US
Practice Address - Phone:817-270-3627
Practice Address - Fax:817-270-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6106207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE82168Medicare UPIN