Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME91045 | FL |
NPI | 1639108111 |
---|---|
Provider Name | Dr. David Jonathan Treloar |
First Address | Sunrise, FL 33323-2865 |
Second Address | Pembroke Pines, FL 33028-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50260 | BLUE SHIELD (01) | FL |
B46125 | (02) |