Provider Demographics
NPI:1528154523
Name:CHAMBERS, COURTNEY EMERSON (MD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:EMERSON
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3590
Mailing Address - Country:US
Mailing Address - Phone:707-646-4180
Mailing Address - Fax:707-646-4185
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:707-646-4180
Practice Address - Fax:707-646-4185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85771208600000X
CT034618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20052765OtherRAILROAD MEDICARE
CA00G857710Medicaid
CA00G857710Medicaid
CA20052765OtherRAILROAD MEDICARE
CTG03789Medicare UPIN
CA00G855710Medicare PIN