Organization
PAUL R. MOULTON, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL R MOULTON M.D. (OWNER)
(207) 945-3619
Entity
Organization
Contact information
Practice address
5 GROVE ST., BANGOR, ME 04401-5394
(207) 945-3619
(207) 941-0817
Mailing address
5 GROVE ST., BANGOR, ME 04401-5394
(207) 945-3619
(207) 941-0817
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
012516
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255330205
—
ME
Enumeration date
10/01/2012
Last updated
10/01/2012
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