Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MAINE 11724 | ME |
NPI | 1093871956 |
---|---|
Provider Name | Owen Delos Buck |
First Address | Lewiston, ME 04240-6578 |
Second Address | Lewiston, ME 04240-6578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |