Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 015495 | CT |
N | 208600000X | Surgeon | 015495 | CT |
N | 2086S0102X | Surgical Critical Care | 015495 | CT |
N | 2086S0129X | Vascular Surgeon | 015495 | CT |
NPI | 1093716938 |
---|---|
Provider Name | Alan David Drezner |
First Address | Avon, CT 06001-2106 |
Second Address | Hartford, CT 06106-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010015495CT01 | ANTHEM BCBS (01) | CT |
070200-0403 | CONNECTICARE (01) | CT |
D74069 | (02) |