Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD12385 | ME |
NPI | 1629052253 |
---|---|
Provider Name | Jorge F Peacher |
First Address | Bar Harbor, ME 04609-1625 |
Second Address | Bar Harbor, ME 04609-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 30/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115769501 | (05) | TX |