Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 2021321 | NY |
N | 2080P0203X | Pediatric Critical Care Doctor | 202132 | NY |
NPI | 1083689384 |
---|---|
Provider Name | Christopher Michael Bryan Heard |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14203-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010201901 | UNIVERA (01) | |
000524184003 | BC/BS (01) | |
0016874670001 | (05) | PA |
01647754 | (05) | NY |
040426001276 | FIDELIS (01) | |
2008190 | IHA (01) | |
G27046 | (02) |