Individual
FREDERICK A VAN MOURIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
116 SHAKER RD, GRAY, GRAY, ME 04039-9629
(207) 657-3308
(207) 657-3309
Mailing address
116 SHAKER RD, GRAY, GRAY, ME 04039-9629
(207) 657-3308
(207) 657-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12383
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000203013
—
ME
Enumeration date
01/13/2006
Last updated
03/21/2008
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