Provider Demographics
NPI:1679580963
Name:NYMAN, ALLAN W (DPM)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:W
Last Name:NYMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4921
Mailing Address - Country:US
Mailing Address - Phone:207-873-2683
Mailing Address - Fax:207-873-2683
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4921
Practice Address - Country:US
Practice Address - Phone:207-873-2683
Practice Address - Fax:207-873-2683
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000591OtherANTHEM BCBS
ME601659Medicare ID - Type Unspecified
T31647Medicare UPIN
ME152624Medicare ID - Type Unspecified