Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD13992 | ME |
NPI | 1396746426 |
---|---|
Provider Name | Brian J Mcgrory |
First Address | Scarborough, ME 04074-9701 |
Second Address | Falmouth, ME 04105-1392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 28/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E64682 | (02) | ME |