Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 049264 | CT |
Y | 208200000X | Surgeon | 049264 | CT |
Y | 208600000X | Surgeon | 049264 | CT |
NPI | 1306898259 |
---|---|
Provider Name | Brian D Shames |
First Address | Farmington, CT 06030-2212 |
Second Address | Farmington, CT 06030-6227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010049264CT02 | ANTHEM BC/BS (01) | CT |
049264 | CONNECTICARE (01) | CT |
1306898259 | (05) | CT |
H78153 | (02) |