Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD19333 | ME |
N | 207QS0010X | Family Doctor - Sports Medicine | MD19333 | ME |
NPI | 1114171857 |
---|---|
Provider Name | Kristen Alyse Scopaz |
First Address | Scarborough, ME 04074-9701 |
Second Address | Scarborough, ME 04074-7163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2008 |
Last Update Date | 26/11/2014 |