Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1093878522 |
---|---|
Provider Name | Mr. John- Paul Donovan |
First Address | Portland, ME 04102-2111 |
Second Address | Portland, ME 04102-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007654 | ANTHEM (01) | ME |