Basic Information
| Provider Information | |||||||||
| NPI: | 1063867489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSSIGNOL | ||||||||
| FirstName: | JARRYD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047360040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074981124 | ||||||||
| FaxNumber: | 2074935340 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 SPRUCE ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077692025 | ||||||||
| FaxNumber: | 2077640629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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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 | 390200000X | MED-RES.LIC 52134 | MT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | DO2904 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14482470 | 01 | CAQH PROVIDER NO. | OTHER | FR8350617 | 01 | DEA | OTHER |