Provider Demographics
NPI:1538139621
Name:CHAMBERS, GARY (DPM)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 S 300 W STE 300
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3654
Mailing Address - Country:US
Mailing Address - Phone:801-273-0001
Mailing Address - Fax:385-900-5928
Practice Address - Street 1:227 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-5500
Practice Address - Country:US
Practice Address - Phone:801-253-6886
Practice Address - Fax:801-253-6888
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12986038-0501207XX0004X, 213ES0131X
NV0001213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2102783Medicaid
NV1538139621Medicaid
UT2102783Medicaid
NV34950Medicare ID - Type Unspecified
NV1538139621Medicaid