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General NPI Number Information
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NPI Number | 1053336206
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Entity Type | Individual
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Provider Name | MICHAEL GILMORE DO
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 824 STILLWATER AVE STE B
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City | BANGOR
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State | ME
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Zip | 04401-3614
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Country | US
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Telephone | 207-941-0080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1328
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City | AUBURN
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State | ME
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Zip | 04211-1328
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Country | US
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Telephone | 207-784-9185
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Fax | 207-784-1594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1808
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License Number State | ME
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