Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 013255 | ME |
NPI | 1043290257 |
---|---|
Provider Name | Thomas Courtney |
First Address | Biddeford, ME 04005-1930 |
Second Address | Biddeford, ME 04005-9400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 14/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F43478 | (02) | ME |