Individual
GARY LEE LAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
580 COTTAGE GROVE RD, SUITE 207, BLOOMFIELD, CT 06002-3088
(860) 242-8644
(860) 242-5017
Mailing address
580 COTTAGE GROVE RD, SUITE 207, BLOOMFIELD, CT 06002-3088
(860) 242-8644
(860) 242-5017
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
23605
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012360581
—
CT
01
—
0100236Q5CT01
BLUE SHIELD
CT
Enumeration date
07/12/2006
Last updated
07/08/2007
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