MEDICARE: MR. GAVIN M DUCKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD015525	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013062348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GAVIN M DUCKER MD

Provider Business Mailing Address
First Line	:	174 KENNEDY MEMORIAL DR
Second Line	:
City	:	WATERVILLE
State	:	ME
Zip	:	04901-5134
Country	:	US
Telephone Number	:	207-861-3338
Fax Number	:	207-861-3281

Provider Business Practice Location Address
First Line	:	300 PROFESSIONAL DR STE 2C
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-8897
Country	:	US
Telephone Number	:	207-883-7926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/08/2024

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