Provider Demographics
NPI:1740386507
Name:KNEEBONE, JAMES ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:KNEEBONE
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 1:42 INDIAN REST RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3737
Mailing Address - Country:US
Mailing Address - Phone:207-725-4556
Mailing Address - Fax:207-725-4979
Practice Address - Street 1:42 INDIAN REST RD
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-3737
Practice Address - Country:US
Practice Address - Phone:207-725-4556
Practice Address - Fax:207-725-4979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1335204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124370000Medicaid
ME124370000Medicaid
MEMM4026Medicare PIN