Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 6372 | NH |
NPI | 1013096098 |
---|---|
Provider Name | Douglas Mcvicar |
First Address | Plymouth, NH 03264 |
Second Address | Plymouth, NH 03264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6372 | STATE LICENSE (01) | NH |
AM9793919 | DEA CERTIFICATE (01) |