Individual
JAIME L PETRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 BRAMHALL ST, PAVILION 1203, PORTLAND, ME 04102
(207) 662-4618
(207) 662-6254
Mailing address
39 WALLACE AVE, SO PORTLAND, ME 04106
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
017196
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30206869
—
NH
05
—
432616699
—
ME
Enumeration date
10/04/2006
Last updated
02/23/2009
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