Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 915 | ME |
NPI | 1073545141 |
---|---|
Provider Name | Russell D Florenz |
First Address | Norway, ME 04268-5664 |
Second Address | Norway, ME 04268-5664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E69093 | (02) |