Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | NH5161 | NH |
NPI | 1275635047 |
---|---|
Provider Name | Dr. Michael Antony Jukes |
First Address | Bailey Island, ME 04003-2540 |
Second Address | Bailey Island, ME 04003-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 11/06/2012 |