Provider Demographics
NPI:1487614277
Name:CHAMBERLAIN, RICHARD JAMES III (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:CHAMBERLAIN
Suffix:III
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 1:4250 E. CAMELBACK ROAD
Mailing Address - Street 2:SUITE K200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8388
Mailing Address - Country:US
Mailing Address - Phone:602-977-0136
Mailing Address - Fax:602-977-0758
Practice Address - Street 1:4250 E. CAMELBACK ROAD
Practice Address - Street 2:SUITE K200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8388
Practice Address - Country:US
Practice Address - Phone:602-977-0136
Practice Address - Fax:602-977-0758
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00116209OtherRAILROAD MEDICARE
AZ314914Medicaid
AZ63884Medicare PIN
AZP00116209OtherRAILROAD MEDICARE
AZ314914Medicaid