Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 010628 | ME |
N | 208600000X | Surgeon | 010628 | ME |
Y | 2086S0129X | Vascular Surgeon | 010628 | ME |
NPI | 1134105075 |
---|---|
Provider Name | William E Herbert |
First Address | Portland, ME 04102-3100 |
Second Address | Portland, ME 04102-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 03/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020000198 | RR MEDICARE (01) | ME |
288070099 | (05) | ME |
30001049 | (05) | NH |
D03563 | (02) |