Healthcare Provider Details

I. General information

NPI: 1407856537
Provider Name (Legal Business Name): LLOYD C CHAMPAGNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E VIRGINIA AVE SUITE 100
PHOENIX AZ
85004-1214
US

IV. Provider business mailing address

PO BOX 7587
PHOENIX AZ
85011-7587
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-4788
  • Fax: 602-258-5131
Mailing address:
  • Phone: 602-258-4788
  • Fax: 602-258-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number27791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: