Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 017302 | ME |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 017302 | ME |
NPI | 1154499002 |
---|---|
Provider Name | Dr. William R Wadland |
First Address | Portland, ME 04104-5040 |
Second Address | Portland, ME 04103-5545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154499002 | (05) | ME |