Provider Demographics
NPI:1548304561
Name:ROY GERMANN, GARY (CRNA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:ROY GERMANN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-6122
Mailing Address - Country:US
Mailing Address - Phone:941-894-7799
Mailing Address - Fax:
Practice Address - Street 1:128 BUCKSPORT RD STE A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2239
Practice Address - Country:US
Practice Address - Phone:207-667-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195787163W00000X
MERNA223059367500000X
FLARNP9308627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9308627OtherLICENSE
FLEX625W-PASCOMedicare PIN
FLP01817188-RAILROADMedicare PIN
FLARNP9308627OtherLICENSE