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General NPI Number Information
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NPI Number | 1316929748
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Entity Type | Individual
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Provider Name | PAUL RICHARD BENOIT JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 925 UNION ST, SUITE 3
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City | BANGOR
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State | ME
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Zip | 04401-1534
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD., SUITE 300
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City | BREWER
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State | ME
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Zip | 04412
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Country | US
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Telephone | 207-973-5035
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Fax | 207-973-5042
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 12849
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | MD20957
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License Number State | ME
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