Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 12815 | ME |
NPI | 1124071543 |
---|---|
Provider Name | Samuel P Hunkler |
First Address | Ellsworth, ME 04605-1534 |
Second Address | Ellsworth, ME 04605-1717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 06/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255383972 | (05) | ME |
F71061 | (02) | ME |