Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 7607529-1205 | UT |
N | 207W00000X | Ophthalmologist | MD.201515 | LA |
Y | 207W00000X | Ophthalmologist | MD21434 | ME |
NPI | 1013191584 |
---|---|
Provider Name | Dr. Jeremy Reid Valentine |
First Address | Bangor, ME 04401-2652 |
Second Address | Millinocket, ME 04462-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013191584 | (05) | ME |