Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1872 | ME |
Y | 207Q00000X | Family Doctor | 1872 | ME |
NPI | 1245268945 |
---|---|
Provider Name | Kris S. Sornberger |
First Address | Bangor, ME 04401-5083 |
Second Address | Bangor, ME 04401-5083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 21/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432502599 | (05) | ME |
MM9086 | (02) | ME |