Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD13868 | OR |
NPI | 1154319226 |
---|---|
Provider Name | Steven Edward Chamberlain |
First Address | Medford, OR 97504-8343 |
Second Address | Medford, OR 97504-8343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213959 | (05) | OR |
E79052 | (02) |