Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | G4061 | TX |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | G4061 | TX |
N | 2086S0120X | Pediatric Surgery | G4061 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G4061 | TX |
NPI | 1922062116 |
---|---|
Provider Name | Dr. John Flynn Teichgraeber |
First Address | Houston, TX 77030-1501 |
Second Address | Houston, TX 77030-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134549803 | CSHCN (01) | TX |
134549805 | (05) | TX |
134549808 | (05) | TX |
81Z234 | BCBSTX (01) | TX |
B26899 | (02) | TX |