Provider Demographics
NPI:1750503124
Name:CHAMBERLIN, GERARD BROPHY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:BROPHY
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6242 E ARBOR AVE
Mailing Address - Street 2:STE 123
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1309
Mailing Address - Country:US
Mailing Address - Phone:480-930-4600
Mailing Address - Fax:480-930-4615
Practice Address - Street 1:6242 E ARBOR AVE
Practice Address - Street 2:STE 123
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-930-4600
Practice Address - Fax:480-930-4615
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41160208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ407911Medicaid