Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 007236 | ME |
NPI | 1013939461 |
---|---|
Provider Name | Edward David |
First Address | Bangor, ME 04401-3990 |
Second Address | Bangor, ME 04401-3990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100543 | ANTHEM BLUE SHIELD (01) | ME |
C66368 | (02) | ME |