Healthcare Provider Details

I. General information

NPI: 1467569871
Provider Name (Legal Business Name): WILLIAM G CHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 MAIN ST
VAN BUREN ME
04785-1028
US

IV. Provider business mailing address

69 MAIN ST
VAN BUREN ME
04785-1028
US

V. Phone/Fax

Practice location:
  • Phone: 207-868-5221
  • Fax: 207-868-5222
Mailing address:
  • Phone: 207-868-5221
  • Fax: 207-868-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOO6961
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: