Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1266 | ME |
NPI | 1457434987 |
---|---|
Provider Name | Dr. Sam M Nawfel |
First Address | Yarmouth, ME 04096-6999 |
Second Address | Yarmouth, ME 04096-6999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017650 | ANTHEM (01) | ME |
E37147 | (02) | ME |