Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 001391 | CT |
NPI | 1609877604 |
---|---|
Provider Name | Dr. Frederick Arthur Barks JR. |
First Address | Putnam, CT 06260-1621 |
Second Address | Putnam, CT 06260-1621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010391 | CONNECTICARE (01) | CT |
050001391CT02 | BLUE CROSS OF CT (01) | CT |
0698592002 | CIGNA (01) | CT |
1030756 | ASHN (01) | CT |
29336-1 | BCBS OF RI (01) | CT |
2V5130 | HEALTHNET (01) | CT |
3823400 | AETNA (01) | CT |
412398 | BLUE CHIP OF RI (01) | RI |
4404611 | UNITED HEALTHCARE (01) | CT |
AA32943 | HARVARD PILGRIM (01) | MA |
P2686322 | OXFORD (01) | CT |
U83407 | (02) | CT |