Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 043162 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 043162 | CT |
NPI | 1063438224 |
---|---|
Provider Name | Douglas Ross Henshaw |
First Address | Danbury, CT 06810-6268 |
Second Address | Danbury, CT 06810-6268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 17/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I28576 | (02) |