Individual
KEY H STAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
33 HIGH ST, CAMDEN, ME 04843-1736
(207) 975-9884
Mailing address
33 HIGH ST, CAMDEN, ME 04843-1736
(207) 975-9884
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
E8185
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123137503
—
TX
Enumeration date
03/16/2006
Last updated
08/09/2010
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