Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4247 | ME |
Y | 213EG0000X | General Practice | 4247 | ME |
NPI | 1003179011 |
---|---|
Provider Name | Travis Castleberry |
First Address | Blue Hill, ME 04614-0628 |
Second Address | Blue Hill, ME 04614-6120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 21/12/2021 |