Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 042845 | CT |
Y | 2081P2900X | Pain Medicine | 042845 | CT |
NPI | 1154346302 |
---|---|
Provider Name | Daniel O Southern |
First Address | Wilton, CT 06897-6014 |
Second Address | Wilton, CT 06897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 27/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I04488 | (02) |