Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 774 | ND |
NPI | 1568557536 |
---|---|
Provider Name | Dr. Derek Teets |
First Address | Minot, ND 58701-5752 |
Second Address | Underwood, ND 58576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |