Provider Demographics
NPI:1225110547
Name:OLIVIER, CHAMION (MD)
Entity Type:Individual
Prefix:
First Name:CHAMION
Middle Name:
Last Name:OLIVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR STE 270
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2454
Mailing Address - Country:US
Mailing Address - Phone:386-344-1699
Mailing Address - Fax:386-263-8880
Practice Address - Street 1:21 HOSPITAL DR STE 270
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2454
Practice Address - Country:US
Practice Address - Phone:386-344-1699
Practice Address - Fax:386-263-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100766207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC28292OtherSTATE MEDICAL LICENSE