Provider Demographics
NPI:1801262845
Name:BUITRAGO, ROY
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:BUITRAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3624
Mailing Address - Country:US
Mailing Address - Phone:207-262-4233
Mailing Address - Fax:207-262-4266
Practice Address - Street 1:849 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3624
Practice Address - Country:US
Practice Address - Phone:207-262-4233
Practice Address - Fax:207-262-4266
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME404237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist