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General NPI Number Information
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NPI Number | 1255386066
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Entity Type | Individual
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Provider Name | JEFFREY J BEAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 335 BRIGHTON AVE STE 200
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City | PORTLAND
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State | ME
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Zip | 04102-2362
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Country | US
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Telephone | 207-662-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 114 MACKWORTH ST
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City | PORTLAND
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State | ME
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Zip | 04103-4534
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Country | US
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Telephone | 207-415-1910
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Fax |
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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 | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 2037
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License Number State | ME
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