Provider Demographics
NPI:1528097623
Name:DEFEO, GUY A (DO)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:A
Last Name:DEFEO
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 1:170 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3130
Mailing Address - Country:US
Mailing Address - Phone:207-324-6197
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:207-324-6197
Practice Address - Fax:207-467-8827
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1313204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM