Individual
DEBORAH J PUCKHABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 MAIN ST, CENTRAL MAINE MEDICAL CENTER, LEWISTON, ME 04240-7027
(207) 795-7575
(207) 795-7193
Mailing address
300 MAIN ST, CENTRAL MAINE MEDICAL CENTER, LEWISTON, ME 04240-7027
(207) 795-5970
(207) 795-7193
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01069603A
IN
207R00000X
Internal Medicine Physician
173763
NY
207R00000X
Internal Medicine Physician
Primary
MD20227
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000745189
ANTHEM PROVIDER NUMBER
IN
01
—
020475714
TAX ID
NH
05
—
201045220
—
IN
05
—
30204794
—
NH
Enumeration date
12/05/2006
Last updated
01/05/2017
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