Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | SC003477L | PA |
Y | 213ES0131X | Foot Surgery | POD229 | ME |
NPI | 1427116300 |
---|---|
Provider Name | Dr. Jil A Beaupain |
First Address | Sherman, ME 04776-0130 |
Second Address | Sherman, ME 04776-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 23/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
POD229 | STATE OF MAINE (01) | ME |