Healthcare Provider Details

I. General information

NPI: 1285664078
Provider Name (Legal Business Name): BRUCE H CHAMBERLAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 S COTTONWOOD ST # L-2
MURRAY UT
84107-5701
US

IV. Provider business mailing address

1121 E 3900 S STE C230
SALT LAKE CITY UT
84124-1297
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-3416
  • Fax: 801-263-3428
Mailing address:
  • Phone: 801-262-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD-45115
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: