Provider Demographics
NPI:1396190781
Name:CLEMMER, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CLEMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3652
Mailing Address - Country:US
Mailing Address - Phone:207-866-0931
Mailing Address - Fax:
Practice Address - Street 1:73 AVENUE LYN LUSI
Practice Address - Street 2:QUARTIER DES VOLCANS
Practice Address - City:GOMA
Practice Address - State:COMMUNE OF GOMA
Practice Address - Zip Code:243
Practice Address - Country:CD
Practice Address - Phone:0024381-387-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine