MEDICARE: DR. ANNE LOUISE CHAMPEAUX 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME93498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14P6P	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639159296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE LOUISE CHAMPEAUX M.D.

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-974-2201
Fax Number	:	813-974-4325

Provider Business Practice Location Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	MDC11
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:	813-974-2201
Fax Number	:	813-974-4280

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/29/2021

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