Active NPI
Frederick A Van Mourik
- Family Medicine Physician
- Gray, ME
National Provider Identifier
1932188323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12383
- Practice address
- 116 Shaker Rd
Gray
Gray, ME 04039-9629 - Phone
- (207) 657-3308
- Fax
- (207) 657-3309
- NPI assigned
- Jan 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12383 | ME | Primary |
Addresses
Primary practice location
116 Shaker Rd
Gray
Gray, ME 04039-9629
Mailing address
116 Shaker Rd
Gray
Gray, ME 04039-9629
Phone (207) 657-3308
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000203013 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12383 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206057600000",
"number": "1932188323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 SHAKER RD",
"address_2": "GRAY",
"city": "GRAY",
"state": "ME",
"postal_code": "040399629",
"telephone_number": "207-657-3308",
"fax_number": "207-657-3309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 SHAKER RD",
"address_2": "GRAY",
"city": "GRAY",
"state": "ME",
"postal_code": "040399629",
"telephone_number": "207-657-3308",
"fax_number": "207-657-3309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN MOURIK",
"first_name": "FREDERICK",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-13",
"last_updated": "2008-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "12383",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000203013",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gray, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.