Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 64587 | CT |
NPI | 1346258803 |
---|---|
Provider Name | Kevin Gregg Billingsley |
First Address | New Haven, CT 06510 |
Second Address | New Haven, CT 06510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 06/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
298450 | (05) | OR |
G48218 | (02) |