Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 032945 | CT |
NPI | 1013011295 |
---|---|
Provider Name | Sally J Irons |
First Address | Middletown, CT 06457 |
Second Address | Middletown, CT 06457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001329459 | (05) | CT |
F55558 | (02) |