Basic Information
| Provider Information | |||||||||
| NPI: | 1528154523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERS | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | EMERSON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 PENNSYLVANIA AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076464180 | ||||||||
| FaxNumber: | 7076464185 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 PENNSYLVANIA AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076464180 | ||||||||
| FaxNumber: | 7076464185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G85771 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 034618 | CT | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 20052765 | 01 | CA | RAILROAD MEDICARE | OTHER | 00G857710 | 05 | CA | MEDICAID |