MEDICARE: GENE CHAMBERS PHD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1205375250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENE CHAMBERS PHD PLLC

Provider Business Mailing Address
First Line	:	2592 N GREGG AVE
Second Line	:	STE 16
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-5543
Country	:	US
Telephone Number	:	479-313-6333
Fax Number	:	479-313-6168

Provider Business Practice Location Address
First Line	:	2592 N GREGG AVE
Second Line	:	STE 16
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-5543
Country	:	US
Telephone Number	:	479-313-6333
Fax Number	:	479-313-6168

Authorized Official
Title or Position	:	OWNER
Name	:	GENE CHAMBERS
Credential	:
Telephone Number	:	479-313-6333

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	02/22/2017

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