Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD20887 | ME |
N | 207X00000X | Orthopaedic Surgeon | 233959 | MA |
NPI | 1013190545 |
---|---|
Provider Name | Ian Noel Tadeo Don Don S Panuncialman |
First Address | Brewer, ME 04412-1005 |
Second Address | Brewer, ME 04412-1519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2007 |
Last Update Date | 09/05/2016 |