Individual
JOHN R. HATZENBUEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 FODEN RD, EAST, SUITE 200, SOUTH PORTLAND, ME 04106
(207) 523-8500
(207) 523-8591
Mailing address
100 GANNETT DRIVE, SUITE C, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD17466
ME
207QS0010X
Sports Medicine (Family Medicine) Physician
MD17466
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30207627
—
NH
05
—
432651599
—
ME
Enumeration date
11/07/2006
Last updated
10/29/2015
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