Individual
BRIGHAM R MCKENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
75 JOHN ROBERTS RD STE 4C, SOUTH PORTLAND, ME 04106-6961
(207) 389-5009
Mailing address
75 JOHN ROBERTS RD STE 4C, SOUTH PORTLAND, ME 04106-6961
(207) 389-5009
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
PA1320
ME
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
PA1320
ME
207XX0801X
Orthopaedic Trauma Physician
PA1320
ME
208100000X
Physical Medicine & Rehabilitation Physician
PA1320
ME
363A00000X
Physician Assistant
PA1320
ME
363AS0400X
Surgical Physician Assistant
PA1320
ME
Other
Enumeration date
03/08/2012
Last updated
12/30/2024
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