Healthcare Provider Details

I. General information

NPI: 1770542912
Provider Name (Legal Business Name): STRATTON JOHN SHANNON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WEST BROADWAY
LINCOLN ME
04457-0000
US

IV. Provider business mailing address

PO BOX 99
LINCOLN ME
04457-0099
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax: 207-794-6691
Mailing address:
  • Phone: 207-794-6700
  • Fax: 207-794-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1569
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: