Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 025898 | CT |
N | 207YS0123X | Facial Plastic Surgeon | 025898 | CT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 025898 | CT |
NPI | 1184650285 |
---|---|
Provider Name | Dr. Stephen M Rouse |
First Address | Willimantic, CT 06226-2122 |
Second Address | Willimantic, CT 06226-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001258987 | (05) | CT |
B39513 | (02) |