Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | DO2999 | ME |
NPI | 1053750349 |
---|---|
Provider Name | Dr. Peter Beaulieu |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401-6616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 04/02/2020 |