Provider Demographics
NPI:1134237456
Name:CHAMBERS, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:#540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-7878
Mailing Address - Fax:417-269-7887
Practice Address - Street 1:3850 S NATIONAL AVE
Practice Address - Street 2:#520
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5287
Practice Address - Country:US
Practice Address - Phone:417-269-7878
Practice Address - Fax:417-269-7887
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209781004Medicaid
G89554Medicare UPIN
080155534Medicare PIN
P00371884Medicare PIN
000094143Medicare PIN
MO209781004Medicaid