Individual
JONATHAN ERIC THYGESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
755 UNIVERSITY AVENUE, SACRAMENTO, CA 95825
(916) 924-8754
(916) 924-1739
Mailing address
755 UNIVERSITY AVENUE, SACRAMENTO, CA 95825
(916) 924-8754
(916) 924-1739
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A75063
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407017800
—
MD
01
—
75859903
BLUE SHIELD
MD
Enumeration date
03/20/2006
Last updated
12/17/2014
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