Healthcare Provider Details

I. General information

NPI: 1043211022
Provider Name (Legal Business Name): BRANDT ERIC RICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E BLUE HILL RD
BLUE HILL ME
04614-5306
US

IV. Provider business mailing address

PO BOX 443
BLUE HILL ME
04614-0443
US

V. Phone/Fax

Practice location:
  • Phone: 207-812-2342
  • Fax:
Mailing address:
  • Phone: 207-374-5007
  • Fax: 207-374-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0066068
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTD071067
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number017950
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: