Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1971 | MA |
Y | 222Z00000X | Podiatrist | 1971 | MA |
N | 2081S0010X | Sports Medicine | 1971 | MA |
N | 213ES0000X | Sports Medicine | 1971 | MA |
N | 213ES0131X | Foot Surgery | 1971 | MA |
NPI | 1013906171 |
---|---|
Provider Name | Bryant A. Tarr |
First Address | Sudbury, MA 01776-2463 |
Second Address | Sudbury, MA 01776-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0357898 | (05) | MA |
U05448 | (02) | MA |