Provider Demographics
NPI:1407881188
Name:DAVID C CHAMPION MD PA
Entity Type:Organization
Organization Name:DAVID C CHAMPION MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-542-4100
Mailing Address - Street 1:3125 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3213
Mailing Address - Country:US
Mailing Address - Phone:956-542-4100
Mailing Address - Fax:956-542-2558
Practice Address - Street 1:3125 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3213
Practice Address - Country:US
Practice Address - Phone:956-542-4100
Practice Address - Fax:956-542-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0070GQ BC/BSOtherMEDICAL DOCTOR
TX181751201Medicaid
TXDF1405OtherRAILROAD MEDICARE
TX0070GQ BC/BSOtherMEDICAL DOCTOR
TXG56326Medicare UPIN