Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 27791 | AZ |
NPI | 1407856537 |
---|---|
Provider Name | Lloyd C Champagne |
First Address | Phoenix, AZ 85011-7587 |
Second Address | Phoenix, AZ 85004-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 05/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
482266 | (05) | AZ |
F46985 | (02) | AZ |
Z131863 | MEDICARE (01) | AZ |