Provider Demographics
NPI:1538120167
Name:GOUDREAU, FRANK SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:SCOTT
Last Name:GOUDREAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073
Mailing Address - Country:US
Mailing Address - Phone:207-459-7195
Mailing Address - Fax:207-459-7609
Practice Address - Street 1:25A JUNE ST STE 16
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2615
Practice Address - Country:US
Practice Address - Phone:207-324-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5101013602207X00000X
MEDO1751208600000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME261390099Medicaid
MM9739Medicare ID - Type Unspecified