Provider Demographics
NPI:1255359626
Name:CHAMPA, JAMES R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CHAMPA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 10490
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-0490
Mailing Address - Country:US
Mailing Address - Phone:307-733-3900
Mailing Address - Fax:307-732-0925
Practice Address - Street 1:555 E BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-3900
Practice Address - Fax:307-732-0925
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY5367A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYF74433Medicare UPIN