Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 011075 | ME |
NPI | 1144242033 |
---|---|
Provider Name | Dr. John Francis Hussey JR. |
First Address | Augusta, ME 04330-6719 |
Second Address | Augusta, ME 04330-6719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011075 | MEDICAL LICENSE (01) | ME |
13548 | MEDICAL LICENSE (01) | NE |
D78813 | (02) | ME |