Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | CT001042 | CT |
N | 111NN1001X | Nutrition | CT001042 | CT |
NPI | 1629135967 |
---|---|
Provider Name | Dr. Bradley Alan Williams |
First Address | New Canaan, CT 06840-5419 |
Second Address | New Canaan, CT 06840-5419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P420681 | OXFORD HEALTH PLANS (01) | CT |
U41692 | (02) | CT |