Healthcare Provider Details

I. General information

NPI: 1790760098
Provider Name (Legal Business Name): JURIS EGILS TREIBERGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 COURT ST
PLYMOUTH MA
02360-4322
US

IV. Provider business mailing address

39 PILGRIM RD
DUXBURY MA
02332-5215
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-2705
  • Fax: 508-747-5209
Mailing address:
  • Phone: 781-934-6387
  • Fax: 508-747-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number56025
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number56025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: