Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 043646 | CT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 043646 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 043646 | CT |
NPI | 1144229840 |
---|---|
Provider Name | Robert Lee Brady |
First Address | Norwalk, CT 06851-1080 |
Second Address | Norwalk, CT 06851-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 16/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146197 | (02) | CT |