Provider Demographics
NPI:1972546406
Name:CHAMBERS, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91569
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-1569
Mailing Address - Country:US
Mailing Address - Phone:562-491-4879
Mailing Address - Fax:562-491-7987
Practice Address - Street 1:231 W VERNON AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2779
Practice Address - Country:US
Practice Address - Phone:323-238-7192
Practice Address - Fax:323-432-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62663208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A626630Medicaid
CAWA62663BMedicare PIN
CA00A626630Medicaid