Provider Demographics
NPI:1669457404
Name:CHAMBERLAIN, BLAKE V (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:V
Last Name:CHAMBERLAIN
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-338-3110
Practice Address - Fax:281-338-3352
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8218207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7964OtherBCBSTX PROV NO
TX8G7964OtherBCBSTX PROV NO
TXP00205568Medicare PIN
TX8C2563Medicare PIN
TX8B5558Medicare PIN
TX8C5855Medicare PIN
TXG15195Medicare UPIN
TXP00127390Medicare PIN