Healthcare Provider Details

I. General information

NPI: 1578623328
Provider Name (Legal Business Name): DR LLOYD P CHAMPAGNE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E VIRGINIA AVE SUITE 119
PHOENIX AZ
85004-1206
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 Number
License Number State

VIII. Authorized Official

Name: LLOYD P CHAMPAGNE JR.
Title or Position: OWNER
Credential: M.D.
Phone: 602-258-4788