Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1486 | ME |
NPI | 1225033277 |
---|---|
Provider Name | Dr. Andrew Haltof |
First Address | Auburn, ME 04210-5853 |
Second Address | Auburn, ME 04210-5853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 19/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133320000 | (05) | ME |
G11327 | (02) | ME |