Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2837 | ME |
N | 207P00000X | Emergency Physician | DO2837 | ME |
NPI | 1417336603 |
---|---|
Provider Name | William Cochran Mcdougall IV |
First Address | Waterville, ME 04901-4974 |
Second Address | Waterville, ME 04901-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 01/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417336603 | (05) | ME |