Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 031736 | CT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 031736 | CT |
NPI | 1295749752 |
---|---|
Provider Name | John M Willett |
First Address | New Haven, CT 06511-5991 |
Second Address | New Haven, CT 06511-5991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 02/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001317363 | (05) | CT |
040004571 | RAILROAD MEDICARE PIN (01) | CT |
E98407 | (02) |