Basic Information
| Provider Information | |||||||||
| NPI: | 1316977697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMPOUX | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 9TH AVE | ||||||||
| Address2: | MS: M4-PFS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065155811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2671 NE 46TH ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981055041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065258000 | ||||||||
| FaxNumber: | 2065258070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD00021525 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | CH8429 | 01 | WA | BLUE SHIELD | OTHER | 0039577 | 01 | WA | LABOR & INDUSTRY | OTHER | US0899652 | 01 | WA | AETNA/USHC PCP | OTHER | 1082445 | 05 | WA | MEDICAID | US4119957 | 01 | WA | AETNA/USHC SPECIALIST | OTHER |