Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 012113 | ME |
NPI | 1003817008 |
---|---|
Provider Name | Diane M Gable |
First Address | Oakland, ME 04963-5364 |
Second Address | Oakland, ME 04963-5364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027880 | BCBS (01) | ME |
E16384 | (02) |