Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS402 | ME |
N | 103TC0700X | Clinical Psychologist | PS402 | ME |
Y | 102L00000X | Psychologist | PS402 | ME |
Y | 103T00000X | Psychologist | PS402 | ME |
N | 103G00000X | Clinical Psychologist | PS402 | ME |
N | 103TC0700X | Clinical Psychologist | PS402 | ME |
N | 103TF0000X | Family Psychologist | PS402 | ME |
N | 103TF0200X | Forensic Psychologist | PS402 | ME |
N | 103TH0100X | Health Service | PS402 | ME |
NPI | 1255492716 |
---|---|
Provider Name | Dr. Robert L. Gallon |
First Address | Bangor, ME 04401-4661 |
Second Address | Bangor, ME 04401-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 22/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003418 | ANTHEM (01) | ME |
2186061 | AETNA (01) | ME |
222380000 | (05) | ME |
E002411 | MARTINS POINT (01) | ME |
R28919 | (02) | ME |