Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME0044584 | FL |
NPI | 1154363620 |
---|---|
Provider Name | Dr. Dudley Gardner Teel |
First Address | Vero Beach, FL 32966-2369 |
Second Address | Vero Beach, FL 32960-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
695629 | (05) | FL |
AT2786967 | DEA (01) | FL |
D63216 | (02) | FL |