Healthcare Provider Details

I. General information

NPI: 1477874873
Provider Name (Legal Business Name): ANDREW WILLIAM CHAMBERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD PAVILION 2, SUITE 431
DALLAS TX
75208-2363
US

IV. Provider business mailing address

221 W COLORADO BLVD PAVILION 2, SUITE 431
DALLAS TX
75208-2363
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-3248
  • Fax: 214-947-3686
Mailing address:
  • Phone: 214-947-3248
  • Fax: 214-947-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10037389
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberQ0422
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number261836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: