Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 015735 | ME |
N | 207PE0004X | Emergency Medical Services | 015735 | ME |
NPI | 1104903525 |
---|---|
Provider Name | Timothy R Fox |
First Address | Damariscotta, ME 04543 |
Second Address | Damariscotta, ME 04543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 02/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432038199 | (05) | ME |
930120493 | RAILROAD MEDICARE (01) | |
H62629 | (02) |