Healthcare Provider Details

I. General information

NPI: 1023039914
Provider Name (Legal Business Name): PAUL PLUMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E CHESTNUT ST
AUGUSTA ME
04330-5717
US

IV. Provider business mailing address

6 E CHESTNUT ST
AUGUSTA ME
04330-5717
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1206
  • Fax:
Mailing address:
  • Phone: 207-626-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA001061
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: