Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 032568 | CT |
NPI | 1053477703 |
---|---|
Provider Name | Mr. Reza Yavari |
First Address | Branford, CT 06405-3773 |
Second Address | Branford, CT 06405-3773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49203 | (02) | CT |