Individual
DR. JOHN EDWARD CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 8TH AVE, SUITE 532, FORT WORTH, TX 76104-2604
(817) 335-4005
(817) 332-3369
Mailing address
800 8TH AVE, SUITE 532, FORT WORTH, TX 76104-2604
(817) 335-4005
(817) 332-3369
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
E2505
TX
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
E2505
TX
208000000X
Pediatrics Physician
E2505
TX
2080A0000X
Pediatric Adolescent Medicine Physician
E2505
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00TD97
BCBS ID NUMBER
TX
05
—
132990602
—
TX
01
—
132990609
TEXAS HEALTH STEPS
TX
01
—
4019283
AETNA HMO PROVIDER ID
TX
Enumeration date
05/08/2006
Last updated
07/01/2009
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