1629004544 NPI number — MR. JOHN PHILIP DOUCETTE P.T.

Table of content: MR. JOHN PHILIP DOUCETTE P.T. (NPI 1629004544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629004544 NPI number — MR. JOHN PHILIP DOUCETTE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUCETTE
Provider First Name:
JOHN
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629004544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 MAIN ST
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
MADAWASKA
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04756-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-728-7778
Provider Business Mailing Address Fax Number:
207-728-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 MAIN ST
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
MADAWASKA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04756-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-728-7778
Provider Business Practice Location Address Fax Number:
207-728-7779
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1548 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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