Provider Demographics
NPI:1407856537
Name:CHAMPAGNE, LLOYD C (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:C
Last Name:CHAMPAGNE
Suffix:
Gender:M
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:PO BOX 7587
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-7587
Mailing Address - Country:US
Mailing Address - Phone:602-258-4788
Mailing Address - Fax:602-258-5131
Practice Address - Street 1:370 E VIRGINIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1214
Practice Address - Country:US
Practice Address - Phone:602-258-4788
Practice Address - Fax:602-258-5131
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277912086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131863OtherMEDICARE
AZ482266Medicaid
AZZ131863OtherMEDICARE
AZ112896Medicare PIN
AZ482266Medicaid
AZ112895Medicare PIN