Healthcare Provider Details

I. General information

NPI: 1316928633
Provider Name (Legal Business Name): JOHN E ERTL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GERMANTOWN RD
DANBURY CT
06810-4087
US

IV. Provider business mailing address

41 GERMANTOWN RD
DANBURY CT
06810-4087
US

V. Phone/Fax

Practice location:
  • Phone: 203-744-1680
  • Fax: 203-792-6510
Mailing address:
  • Phone: 203-744-1680
  • Fax: 203-792-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number020601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: