Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 032386 | CT |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 032386 | CT |
NPI | 1093741654 |
---|---|
Provider Name | Peter Stuart Boone |
First Address | Hamden, CT 06518-3209 |
Second Address | Trumbull, CT 06611-4552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D19910 | (02) |