MEDICARE: DR. GRETCHEN ANN CHAMPION M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	M0684	TX

General Provider Information

NPI Number	:	1104869866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN ANN CHAMPION M.D.

Provider Business Mailing Address
First Line	:	1105 NORTH CENTRAL EXPRESSWAY, SUITE 210
Second Line	:	ALLEN EAR, NOSE, THROAT, & ALLERGY, P.A.
City	:	ALLEN
State	:	TX
Zip	:	75013
Country	:	US
Telephone Number	:	972-747-4646
Fax Number	:	972-747-4633

Provider Business Practice Location Address
First Line	:	1105 NORTH CENTRAL EXPRESSWAY, SUITE 210
Second Line	:	ALLEN EAR, NOSE, THROAT, & ALLERGY, P.A.
City	:	ALLEN
State	:	TX
Zip	:	75013
Country	:	US
Telephone Number	:	972-747-4646
Fax Number	:	972-747-4633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/23/2007

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