Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 024823 | CT |
NPI | 1053318345 |
---|---|
Provider Name | George Y Wu |
First Address | Farmington, CT 06030-2212 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 14/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1248236 | (05) | CT |
E11046 | (02) | CT |