Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1117 | ME |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 1117 | ME |
NPI | 1023165081 |
---|---|
Provider Name | Maurice Pare |
First Address | Bangor, ME 04401-5609 |
Second Address | Bangor, ME 04401-5609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 26/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061193 | ANTHEM BC (01) | ME |
F64380 | (02) | ME |
F64380 | (05) | ME |