Basic Information
| Provider Information | |||||||||
| NPI: | 1225236946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 JOHN FREEMAN BLVD. | ||||||||
| Address2: | JJL S80-10 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135006325 | ||||||||
| FaxNumber: | 7135000706 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 JOHN FREEMAN BLVD. | ||||||||
| Address2: | JJL S80-10 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135006325 | ||||||||
| FaxNumber: | 7135000706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G73588 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME97508 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0256332 | 05 | CA | MEDICAID | 1225236946 | 01 | NPI | OTHER | G73588 | 01 | MEDICAL BOARD OF CALIFORNIA | OTHER | 22886 | 01 | MS | MISSISSIPPI MEDICAL LICENSE | OTHER | ME97508 | 01 | MEDICAL BOARD OF FLORIDA | OTHER |