Individual
SAMUEL GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
265 WESTERN AVE STE 2, SOUTH PORTLAND, ME 04106-2458
(207) 661-0200
(207) 661-0299
Mailing address
265 WESTERN AVE STE 2, SOUTH PORTLAND, ME 04106-2458
(207) 661-0200
(207) 661-0299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1456
ME
Other
Enumeration date
03/16/2012
Last updated
06/14/2021
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