Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 51311 | AZ |
NPI | 1063421766 |
---|---|
Provider Name | Dr. Ronald Scott Chamberlain |
First Address | Phoenix, AZ 85016-4740 |
Second Address | Phoenix, AZ 85016-4740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 27/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171481 | (05) | AZ |
F90824 | (02) | |
Z209179 | MEDICARE (01) | AZ |