Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3079 | ME |
NPI | 1073659538 |
---|---|
Provider Name | Dr. William Alexander Deighan |
First Address | Newburgh, ME 04444-4947 |
Second Address | Bangor, ME 04401-4721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T31315 | (02) | ME |