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General NPI Number Information
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NPI Number | 1487684346
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Entity Type | Organization
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Legal Business Name | CONNECTICUT FOOT SPECIALISTS, P.C.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 11 SOUTH RD LOWR LEVEL20
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City | FARMINGTON
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State | CT
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Zip | 06032-2483
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Country | US
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Telephone | 860-470-5703
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Fax | 860-909-0506
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Provider Business Mailing Address
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Address Line | 11 SOUTH RD LOWR LEVEL20
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City | FARMINGTON
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State | CT
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Zip | 06032-2483
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Country | US
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Telephone | 860-470-5703
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Fax | 860-909-0506
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN KEITH WAGNER
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Credential | DPM
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Telephone | 860-470-5703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000144
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License Number State | CT
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