Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10042 | MA |
Y | 213EG0000X | General Practice | 10042 | MA |
NPI | 1003893884 |
---|---|
Provider Name | Dr. Robert George Paquette |
First Address | Raynham, MA 02767-1628 |
Second Address | Raynham, MA 02767-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10042 | STATE LICENCE NUMBER (01) | MA |