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Individual

JEREMY MORETZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7861

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A119960
CA
2085R0202X
Diagnostic Radiology Physician
Primary
MD24387
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1235454919
ME
Enumeration date
04/06/2010
Last updated
03/02/2021
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