Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A114696 | CA |
NPI | 1821219270 |
---|---|
Provider Name | Jason Paul Champagne |
First Address | San Francisco, CA 94115-1809 |
Second Address | San Francisco, CA 94115-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/02/2012 |