Provider Demographics
NPI:1891181194
Name:CHAMION N. OLIVIER MD PA
Entity Type:Organization
Organization Name:CHAMION N. OLIVIER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAMION
Authorized Official - Middle Name:N
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-263-8855
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2452
Mailing Address - Country:US
Mailing Address - Phone:386-263-8855
Mailing Address - Fax:386-467-7732
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 290
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2452
Practice Address - Country:US
Practice Address - Phone:386-263-8855
Practice Address - Fax:386-467-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100766207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty