Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | H2828 | TX |
NPI | 1154300788 |
---|---|
Provider Name | David Crockett Teller |
First Address | Austin, TX 78744-3111 |
Second Address | Austin, TX 78744-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 15/12/2016 |