Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 012519 | ME |
N | 208200000X | Surgeon | 012519 | ME |
N | 208600000X | Surgeon | 012519 | ME |
NPI | 1306840806 |
---|---|
Provider Name | Bruce E Leiter |
First Address | Lewiston, ME 04241-1849 |
Second Address | Rockport, ME 04856-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A39407 | (02) | ME |