Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 028220 | CT |
NPI | 1073513685 |
---|---|
Provider Name | David A Roer |
First Address | Middlebury, CT 06762-2843 |
Second Address | Middlebury, CT 06762-2843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 13/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001282201 | (05) | CT |
D95803 | (02) |