Provider Demographics
NPI: | 1700857729 |
---|---|
Name: | CHAMBERS, DAVID LYNN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DAVID |
Middle Name: | LYNN |
Last Name: | CHAMBERS |
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: | 920 W IRONWOOD DR |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | COEUR D ALENE |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83814-2463 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-667-4557 |
Mailing Address - Fax: | 208-765-2887 |
Practice Address - Street 1: | 920 W IRONWOOD DR |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | COEUR D ALENE |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83814-2463 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-667-4557 |
Practice Address - Fax: | 208-765-2887 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-28 |
Last Update Date: | 2012-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | M-4771 | 207Q00000X |
ID | M4771 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | 003641300 | Medicaid | |
ID | A07859 | Medicare UPIN | |
ID | 1116666 | Medicare ID - Type Unspecified |