Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 034635 | CT |
Y | 207X00000X | Orthopaedic Surgeon | 34635 | CT |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 34635 | CT |
NPI | 1447247606 |
---|---|
Provider Name | John D Mccallum III |
First Address | Hamden, CT 06518-3209 |
Second Address | Hamden, CT 06518-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G05551 | (02) | CT |