Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1313 | ME |
NPI | 1528097623 |
---|---|
Provider Name | Guy A Defeo |
First Address | Alfred, ME 04002-3130 |
Second Address | Alfred, ME 04002-3130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 22/09/2008 |