Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 016009 | ME |
NPI | 1386625572 |
---|---|
Provider Name | Dr. John W. Hall |
First Address | Portland, ME 04103-1073 |
Second Address | Scarborough, ME 04074-8926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187870099 | (05) | ME |
30209639 | (05) | NH |
G58063 | (02) |