Provider Demographics
NPI:1215920319
Name:CHAMBERS, RONALD G I (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:CHAMBERS
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 ASHBY CT
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9215
Mailing Address - Country:US
Mailing Address - Phone:530-275-3094
Mailing Address - Fax:530-275-0803
Practice Address - Street 1:4174 ASHBY CT
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9215
Practice Address - Country:US
Practice Address - Phone:530-275-3094
Practice Address - Fax:530-275-0803
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0714372OtherCLIA NUMBER
CA21565OtherWEB MD ACCT NUMBER
CABLUE CROSSOther00G271700
CA4490118OtherMEDI-CAL PIN NUMBER
CA1243370356OtherVITERA ACCOUNT
CA1861616567Medicaid
CAZZZ01370ZOtherMEDICARE PTAN
CABLUE SHIELDOther00G271700
ZZZ01370ZOtherMEDICARE ID
CA00G271700OtherBLUE SHIELD ID NUMBER
CA00G271700Medicaid
CA013204OtherAMER BD OF FAMILY PRACTIC
CAG27170OtherCALIF STATE LICENSE NUMBE
CAG27170OtherCALIF STATE LICENSE NUMBE
CA21565OtherWEB MD ACCT NUMBER
CA00G271700Medicaid
CAZZZ01370ZOtherMEDICARE PTAN