Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 031761 | CT |
NPI | 1053410712 |
---|---|
Provider Name | Ralph Peter Stocker |
First Address | Glastonbury, CT 06033-1208 |
Second Address | Glastonbury, CT 06033-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 14/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B83054 | (02) |