Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 030754 | CT |
NPI | 1033105929 |
---|---|
Provider Name | Dr. Wayne Ian Larrison |
First Address | New Haven, CT 06519-1600 |
Second Address | New Haven, CT 06519-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E09903 | (02) | CT |