Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CR1402 | ME |
NPI | 1518939859 |
---|---|
Provider Name | Dr. James Ronald Lavallee |
First Address | Augusta, ME 04330-7809 |
Second Address | Augusta, ME 04330-7809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 09/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
422800000 | (05) | ME |
V02383 | (02) | ME |