Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DO2930 | ME |
NPI | 1063502995 |
---|---|
Provider Name | Christopher A Regnier |
First Address | South Portland, ME 04106-3266 |
Second Address | Brunswick, ME 04011-2092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063502995 | (05) | ME |
VAD000 | (02) | FL |