Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 012185 | CT |
NPI | 1013276716 |
---|---|
Provider Name | Dr. Ashbel G. Gulliver Jr JR. |
First Address | Shelton, CT 06484 |
Second Address | Shelton, CT 06484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 15/05/2012 |