Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1170 | ME |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 1170 DO | ME |
NPI | 1306998281 |
---|---|
Provider Name | Dr. James Nelson Riley SR. |
First Address | Brewer, ME 04412-2351 |
Second Address | Bangor, ME 04401-2311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123700099 | (05) | ME |
D93059 | (02) | ME |