Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 000504 | CT |
N | 222Z00000X | Podiatrist | 000504 | CT |
Y | 213ES0131X | Foot Surgery | 000504 | CT |
NPI | 1346216900 |
---|---|
Provider Name | Dr. Brian Peter Deschamps |
First Address | Waterford, CT 06385-1234 |
Second Address | Vernon, CT 06066-4040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 23/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T91425 | (02) | CT |