Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 036866 | CT |
NPI | 1285657825 |
---|---|
Provider Name | Dr. Robert T. Brautigam |
First Address | Hartford, CT 06151-0634 |
Second Address | Hartford, CT 06106-5523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 25/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001368661 | (05) | CT |
H34947 | (02) | CT |