Individual
DR. BRADLEY PAUL CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 DRURY LN, LAFAYETTE, LA 70508-5702
(337) 233-0219
(337) 233-2418
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 233-0219
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
206155
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2147846
—
LA
01
—
600535AI32
MEDICARE
—
05
—
INTERN
—
LA
Enumeration date
06/10/2011
Last updated
10/18/2021
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