Individual
JOEL L BOTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
84 MARGINAL WAY, SUITE 700, PORTLAND, ME 04101-2443
(207) 774-5816
(207) 523-8597
Mailing address
100 FODEN RD, WEST, SUITE 203, SOUTH PORTLAND, ME 04106-2319
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
010885
ME
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
010885
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010554
ANTHEM
—
01
—
1040536
AETNA
—
05
—
290910099
—
ME
Enumeration date
03/16/2006
Last updated
03/03/2011
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