Basic Information
| Provider Information | |||||||||
| NPI: | 1881680072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAXTON | ||||||||
| FirstName: | EDMUND | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077952800 | ||||||||
| FaxNumber: | 2077952808 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077952805 | ||||||||
| FaxNumber: | 2077952190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 02/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9652 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 279820099 | 05 | ME | MEDICAID |