Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | ME0093552 | FL |
N | 207Q00000X | Family Doctor | 44018 | KY |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD19592 | ME |
NPI | 1851392385 |
---|---|
Provider Name | Dr. Timothy F Pruchnic |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-6616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 13/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000729969 | BCBS (01) | KY |
P00974623 | RR MEDICARE (01) | KY |