Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | CT042653 | CT |
NPI | 1578595237 |
---|---|
Provider Name | Gary Richard Richo |
First Address | Shelton, CT 06484-7622 |
Second Address | Shelton, CT 06484-7622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 18/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12010 | (02) | CT |