Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | F7643 | TX |
NPI | 1508822602 |
---|---|
Provider Name | Joseph T Tretta |
First Address | Jacksonville, FL 32256-6017 |
Second Address | Palestine, TX 75801-6958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033590303 | (05) | TX |
B27072 | (02) |