Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | M5871 | TX |
Y | 204F00000X | Transplant Surgeon | MD19892 | ME |
N | 208200000X | Surgeon | M5871 | TX |
N | 208600000X | Surgeon | M5871 | TX |
NPI | 1528072675 |
---|---|
Provider Name | Juan M Palma-Vargas |
First Address | Scarborough, ME 04074-9701 |
Second Address | Portland, ME 04102-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 20/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188994101 | (05) | TX |
188994102 | (05) | TX |
188994103 | CSN (01) | TX |
8BX129 | BCBS (01) | TX |
P00736439 | RAILROAD (01) | TX |