Provider Demographics
NPI:1710059902
Name:STILLSON, LINFORD J (DO)
Entity Type:Individual
Prefix:DR
First Name:LINFORD
Middle Name:J
Last Name:STILLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2872
Mailing Address - Country:US
Mailing Address - Phone:207-591-6701
Mailing Address - Fax:207-591-6704
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2872
Practice Address - Country:US
Practice Address - Phone:207-591-6701
Practice Address - Fax:207-591-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG29601Medicare UPIN