Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD13824 | ME |
NPI | 1285656413 |
---|---|
Provider Name | Dr. Brian Patrick O'donnell |
First Address | Freeport, ME 04032-7023 |
Second Address | Freeport, ME 04032-7023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 15/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010527189 | (05) | ME |
F67782 | (02) | ME |