Healthcare Provider Details

I. General information

NPI: 1831490820
Provider Name (Legal Business Name): TARAH CHAMBERLAIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HIGHWAY 50
GILLETTE WY
82718-9330
US

IV. Provider business mailing address

469 STATE HIGHWAY 50
GILLETTE WY
82718-9330
US

V. Phone/Fax

Practice location:
  • Phone: 73-879-8503
  • Fax: 307-387-9890
Mailing address:
  • Phone: 307-387-9850
  • Fax: 307-387-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15755A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: