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General NPI Number Information
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NPI Number | 1538120167
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Entity Type | Individual
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Provider Name | FRANK SCOTT GOUDREAU DO
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 25A JUNE ST STE 16
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City | SANFORD
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State | ME
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Zip | 04073-2615
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Country | US
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Telephone | 207-324-1488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 233
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City | SANFORD
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State | ME
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Zip | 04073
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Country | US
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Telephone | 207-459-7195
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Fax | 207-459-7609
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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 | 5101013602
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DO1751
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | DO1751
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License Number State | ME
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