Provider Demographics
NPI:1861526352
Name:JOSEPH T. TRETTA, DO, PA
Entity type:Organization
Organization Name:JOSEPH T. TRETTA, DO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-723-9009
Mailing Address - Street 1:123 MEDICAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8507
Mailing Address - Country:US
Mailing Address - Phone:903-723-9009
Mailing Address - Fax:903-723-0236
Practice Address - Street 1:123 MEDICAL DR STE A
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8507
Practice Address - Country:US
Practice Address - Phone:903-723-9009
Practice Address - Fax:903-723-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7643207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033NAOtherBLUE CROSS BLUE SHIED
TX00765ZMedicare PIN
B27072Medicare UPIN