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General NPI Number Information
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NPI Number | 1912999608
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Entity Type | Individual
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Provider Name | BRUCE CHAMPAGNE MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2101 CENTREPARK WEST DR. SUITE 175
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City | WEST PALM BEACH
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State | FL
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Zip | 33409
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Country | UM
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Telephone | 561-242-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 CENTRE PARK WEST DR STE 175
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6466
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Country | US
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Telephone | 561-242-3009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 119752
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 175085
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License Number State | NY
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