Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD7571 | RI |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD07571 | RI |
NPI | 1407818966 |
---|---|
Provider Name | Dr. Raymond G Dufresne JR. |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9006557 | (05) | RI |
D71831 | (02) | RI |