Healthcare Provider Details

I. General information

NPI: 1992776017
Provider Name (Legal Business Name): GENE ROYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN ST
PORTER ME
04068-3527
US

IV. Provider business mailing address

253 BRIDGTON RD
FRYEBURG ME
04037-1438
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-8126
  • Fax: 207-625-7820
Mailing address:
  • Phone: 207-935-3383
  • Fax: 207-935-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1155
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: