Provider Demographics
NPI:1639285422
Name:DEMOYA, JOSE D (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:D
Last Name:DEMOYA
Suffix:
Gender:M
Credentials:MD
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 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-7045
Mailing Address - Fax:207-474-6355
Practice Address - Street 1:46 FAIRVIEW AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-474-7045
Practice Address - Fax:207-474-6355
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17340208600000X
NMMD2005-0128208600000X
KY24310208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED82714Medicare UPIN