Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000188 | CT |
Y | 222Z00000X | Podiatrist | 000188 | CT |
NPI | 1013917004 |
---|---|
Provider Name | Dr. Robert E. Sherman |
First Address | Stratford, CT 06614-4118 |
Second Address | Stratford, CT 06614-4118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000188 | STATE LICENSE (01) | CT |
000957 | HEALTHNET PROVIDER NUMBER (01) | CT |
01000188 | CIGNA PROVIDER NUMBER (01) | CT |
030000188CT01 | ANTHEM BLUE CROSS BLUE SH (01) | CT |
10451287 | CAQH PROVIDER NUMBER (01) | CT |
188100 | CONNECTICARE PROVIDER NO. (01) | CT |
915 | CT DRUG REG. NUMBER (01) | CT |
AS1512397 | FEDERAL DEA NUMBER (01) | CT |
T22205 | (02) | CT |