Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | OS15104 | FL |
NPI | 1043298706 |
---|---|
Provider Name | Dr. Donna B Treesh |
First Address | Jacksonville, FL 32209 |
Second Address | Jacksonville, FL 32209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292650400 | (05) | FL |
P00422778 | RAILROAD MEDICARE (01) | |
Q02170 | (02) |