Healthcare Provider Details

I. General information

NPI: 1164660783
Provider Name (Legal Business Name): JOHN F. GADDIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FACTORY ROAD
EAST MACHIAS ME
04630-0189
US

IV. Provider business mailing address

P.O. BOX 189 FACTORY ROAD
EAST MACHIAS ME
04630-0189
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-3338
  • Fax: 307-355-0534
Mailing address:
  • Phone: 207-255-3338
  • Fax: 207-255-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number1034
License Number StateME

VIII. Authorized Official

Name: JOHN F. GADDIS
Title or Position: OWNER
Credential: D.O.
Phone: 207-255-3338