Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 025550 | CT |
NPI | 1760408538 |
---|---|
Provider Name | Kurt J Myers |
First Address | Waterbury, CT 06706-1221 |
Second Address | Waterbury, CT 06706-1221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B37852 | (02) | CT |