Individual
DR. JONATHAN S. DEITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 680, FORT WORTH, TX 76104-2133
(817) 250-4235
Mailing address
1325 PENNSYLVANIA AVE STE 680, FORT WORTH, TX 76104-2133
(817) 250-4235
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
194966-1
NY
2086S0129X
Vascular Surgery Physician
Primary
T3610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01921764
—
NY
Enumeration date
01/03/2006
Last updated
10/20/2021
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