Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 46523-020 | WI |
NPI | 1013954080 |
---|---|
Provider Name | Theodore C Pratt |
First Address | San Diego, CA 92127-1260 |
Second Address | La Jolla, CA 92037-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 07/10/2019 |