Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 9234 | ND |
NPI | 1023105020 |
---|---|
Provider Name | Charles R Gasser |
First Address | Lewiston, ME 04240-7634 |
Second Address | Lewiston, ME 04240-7634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12080 | (05) | ND |
F01093 | (02) |