Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 009535 | ME |
NPI | 1013913433 |
---|---|
Provider Name | Dr. Ali Khavari |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 28/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110720099 | (05) | ME |
B86821 | (02) | ME |