MEDICARE: MICHAEL PAUL CHAMBERS PA

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	PA2013-0079	NM

General Provider Information

NPI Number	:	1619077120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PAUL CHAMBERS PA

Provider Business Mailing Address
First Line	:	3105 NIESE CT SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87121-6973
Country	:	US
Telephone Number	:	505-515-5554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 RIDGECREST DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5129
Country	:	US
Telephone Number	:	505-717-3262
Fax Number	:

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	05/01/2017

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