MEDICARE: IAN JAMES CHAMBERLAIN PA-C

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	363A00000X	Physician Assistant	055.0040402	VT
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1093521221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN JAMES CHAMBERLAIN PA-C

Provider Business Mailing Address
First Line	:	1021 NE 6TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1113
Country	:	US
Telephone Number	:	702-538-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 NE 6TH ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1113
Country	:	US
Telephone Number	:	541-672-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	06/18/2026

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