Provider Demographics
NPI:1760483424
Name:DANIEL, CHALMERS BEDFORD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHALMERS
Middle Name:BEDFORD
Last Name:DANIEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 E. VIA LINDA,
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-454-2371
Mailing Address - Fax:480-454-2375
Practice Address - Street 1:9060 E. VIA LINDA
Practice Address - Street 2:SUITE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-454-2371
Practice Address - Fax:480-454-2375
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN9529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153158OtherBCBS
AR93159OtherBCBS
RAIL ROAD MEDICAREOther110218391
AR93159OtherBCBS
RAIL ROAD MEDICAREOther110218391
AR107001001Medicare PIN