Basic Information
| Provider Information | |||||||||
| NPI: | 1891865408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMPLIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4373 MEADOW CIR | ||||||||
| Address2: | |||||||||
| City: | RESCUE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956729436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306765813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6651 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169651111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 00G531130 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.