Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | G8457 | TX |
NPI | 1366498438 |
---|---|
Provider Name | Dr. David Edward Teitelbaum |
First Address | Fort Worth, TX 76107-3864 |
Second Address | Fort Worth, TX 76107-3864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P000GQ538 | (05) | TX |