Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 6043 | NH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 6043 | NH |
NPI | 1033108568 |
---|---|
Provider Name | Gerard J Hevern |
First Address | Suncook, NH 03275-9001 |
Second Address | Allenstown, NH 03275-2366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 02/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105430YPNH01 | ANTHEM (01) | |
30010691 | (05) | NH |
B86137 | (02) |