Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1439 | ME |
NPI | 1316353170 |
---|---|
Provider Name | Peter Kouros |
First Address | Cape Elizabeth, ME 04107-2103 |
Second Address | Cape Elizabeth, ME 04107-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 01/07/2014 |