Provider Demographics
NPI:1659806644
Name:CHAMPION, NICHOLAS TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:TYLER
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:195 CENTER RD STE B
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5565
Mailing Address - Country:US
Mailing Address - Phone:941-492-6227
Mailing Address - Fax:941-492-6335
Practice Address - Street 1:195 CENTER RD STE B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5565
Practice Address - Country:US
Practice Address - Phone:941-492-6227
Practice Address - Fax:941-492-6335
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME158384208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery