Provider Demographics
NPI:1912155003
Name:GUY A. DEFEO D.O., LLC
Entity Type:Organization
Organization Name:GUY A. DEFEO D.O., LLC
Other - Org Name:GUY A. DEFEO D.O., LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-467-5932
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0135
Mailing Address - Country:US
Mailing Address - Phone:207-467-5932
Mailing Address - Fax:207-467-8827
Practice Address - Street 1:170 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:ME
Practice Address - Zip Code:04002-3130
Practice Address - Country:US
Practice Address - Phone:207-467-5932
Practice Address - Fax:207-467-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1313204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty