Healthcare Provider Details

I. General information

NPI: 1285649988
Provider Name (Legal Business Name): DAVID CHAMBERLAND MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 POPLAR DR
MEDFORD OR
97504-5207
US

IV. Provider business mailing address

1365 POPLAR DR
MEDFORD OR
97504-5207
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-2233
  • Fax: 541-773-2233
Mailing address:
  • Phone: 541-773-2233
  • Fax: 541-773-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD26693
License Number StateOR

VIII. Authorized Official

Name: DAVID CHAMBERLAND
Title or Position: PRESIDENT/SECRETARY
Credential: MD
Phone: 541-773-2233