Provider Demographics
NPI:1366702359
Name:TATREAU, JASON RYAN (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:TATREAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2213 ELBA ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3934
Mailing Address - Country:US
Mailing Address - Phone:919-684-0100
Mailing Address - Fax:919-681-2785
Practice Address - Street 1:2213 ELBA ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3934
Practice Address - Country:US
Practice Address - Phone:919-684-0100
Practice Address - Fax:919-681-2785
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2013-015592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty