=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871586057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN DUERR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2005
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 MAIN ST
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-378-4500
-----------------------------------------------------
Fax | 203-378-8220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 MAIN ST
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614-4946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-378-4500
-----------------------------------------------------
Fax | 203-378-8220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 16863
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------