Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 000533 | CT |
N | 207Q00000X | Family Doctor | 000533 | CT |
NPI | 1407876733 |
---|---|
Provider Name | Dr. William Joseph Garrity |
First Address | Suffield, CT 06078-2094 |
Second Address | Suffield, CT 06078-2094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 18/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H60630 | (02) | CT |