Individual
BRIAN D SHAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, GENERAL SURGERY, FARMINGTON, CT 06030-6227
(860) 679-8080
(860) 679-1420
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT OFFICE, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
049264
CT
208600000X
Surgery Physician
Primary
049264
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010049264CT02
ANTHEM BC/BS
CT
01
—
049264
CONNECTICARE
CT
05
—
1306898259
—
CT
Enumeration date
05/17/2006
Last updated
09/20/2022
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