Provider Demographics
NPI:1013062348
Name:DUCKER, GAVIN M (MD)
Entity Type:Individual
Prefix:MR
First Name:GAVIN
Middle Name:M
Last Name:DUCKER
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 1:174 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5134
Mailing Address - Country:US
Mailing Address - Phone:207-861-3338
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:300 PROFESSIONAL DR STE 2C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8897
Practice Address - Country:US
Practice Address - Phone:207-883-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD015525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME116010200Medicaid
MEMM884601Medicare PIN
MEH36301Medicare UPIN
ME208504Medicare ID - Type UnspecifiedRHC PROVIDER NUMBER