Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 027731 | CT |
N | 111NI0900X | Internist | 027731 | CT |
Y | 207RG0100X | Gastroenterologist | 027731 | CT |
NPI | 1043396112 |
---|---|
Provider Name | Dr. Gerald George Fette |
First Address | Derby, CT 06418-1328 |
Second Address | Derby, CT 06418-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D80735 | (02) | CT |