Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 231206 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 231206 | NY |
NPI | 1548238538 |
---|---|
Provider Name | Dr. Andrew Bruce Symons |
First Address | Buffalo, NY 14215 |
Second Address | Tonawanda, NY 14150-9407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02670042 | (05) | NY |
I30729 | (02) |