Healthcare Provider Details

I. General information

NPI: 1114071446
Provider Name (Legal Business Name): JOHN PAUL CARRIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DONALD B DEAN DR
SOUTH PORTLAND ME
04106-3252
US

IV. Provider business mailing address

21 DONALD B DEAN DR
SOUTH PORTLAND ME
04106-3252
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1800
  • Fax: 207-871-1818
Mailing address:
  • Phone: 207-871-1800
  • Fax: 207-871-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number010750
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: