Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 006593 | ME |
NPI | 1033199658 |
---|---|
Provider Name | Edward B Gilmore |
First Address | Bar Harbor, ME 04609-1625 |
Second Address | Bar Harbor, ME 04609-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 21/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006593 | ME LICENSE (01) | ME |
16563 | ANTHEM (01) | ME |
1790764512-010 | (05) | ME |
B86689 | (02) | ME |