Healthcare Provider Details

I. General information

NPI: 1457433476
Provider Name (Legal Business Name): DONALD RAYMOND BEBB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HANCOCK STREET BANGOR VA CLINIC
BANGOR ME
04401
US

IV. Provider business mailing address

97 MAIN TRL
HAMPDEN ME
04444-1515
US

V. Phone/Fax

Practice location:
  • Phone: 207-561-3600
  • Fax: 207-947-1862
Mailing address:
  • Phone: 207-862-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number015881
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: