Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 024179 | CT |
N | 208600000X | Surgeon | 024179 | CT |
N | 2086S0105X | Surgery of the Hand | 024179 | CT |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 024179 | CT |
NPI | 1821031899 |
---|---|
Provider Name | Mr. David Jay Goodkind |
First Address | Branford, CT 06405 |
Second Address | Branford, CT 06405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 04/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001241793 | (05) | CT |
1241793 | (05) | CT |
240000048 | (02) | CT |
A38161 | (02) | CT |