Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | L-228993 | MA |
N | 208600000X | Surgeon | L-228993 | MA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 17368 | NH |
N | 2086S0122X | Plastic and Reconstructive Surgery | 242158 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD20009 | ME |
NPI | 1235266677 |
---|---|
Provider Name | Dr. John C. Kirkham |
First Address | South Portland, ME 04106-2430 |
Second Address | South Portland, ME 04106-2430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 02/03/2020 |