Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 011123 | ME |
N | 207Q00000X | Family Doctor | 011123 | ME |
NPI | 1073736930 |
---|---|
Provider Name | David G Millay |
First Address | Boothbay Harbor, ME 04538-0417 |
Second Address | Boothbay Harbor, ME 04538-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C66186 | (02) | |
ME5569 | (05) | ME |