Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 26116 | CT |
NPI | 1013016187 |
---|---|
Provider Name | Dr. Jonathan H Tress |
First Address | Hartford, CT 06106-2528 |
Second Address | Hartford, CT 06106-2528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B 38022 | (02) | CT |