MEDICARE: JON C OLDER DO

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	207R00000X	Internal Medicine Physician	DO1652	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	:	1073582128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON C OLDER DO

Provider Business Mailing Address
First Line	:	20 HARTFORD ST
Second Line	:
City	:	HOULTON
State	:	ME
Zip	:	04730-1891
Country	:	US
Telephone Number	:	207-532-2900
Fax Number	:	207-532-5974

Provider Business Practice Location Address
First Line	:	20 HARTFORD ST
Second Line	:
City	:	HOULTON
State	:	ME
Zip	:	04730-1891
Country	:	US
Telephone Number	:	207-532-2900
Fax Number	:	207-532-5974

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	05/04/2017

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Directions to “ JON C OLDER DO” Practice Location

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