Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 017618 | ME |
NPI | 1033126826 |
---|---|
Provider Name | Dr. Thalia Mayes |
First Address | Portland, ME 04101-2438 |
Second Address | Portland, ME 04101-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 23/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432967599 | (05) | ME |