Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 384338 | MA |
NPI | 1104138106 |
---|---|
Provider Name | Dr. Jean Claude Petit Me |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Fairhaven, MA 02719-5208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2010 |
Last Update Date | 29/03/2021 |