Healthcare Provider Details

I. General information

NPI: 1780667873
Provider Name (Legal Business Name): WILLIAM E HEAD PA-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 ENFIELD RD
LINCOLN ME
04457-4146
US

IV. Provider business mailing address

815 MAIN ST
LINCOLN ME
04457-4606
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3085
  • Fax: 207-794-2847
Mailing address:
  • Phone: 207-794-3085
  • Fax: 207-794-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-162
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: