Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 36840 | NC |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 36840 | NC |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 36840 | NC |
NPI | 1720062110 |
---|---|
Provider Name | Robert Douglas Teasdall |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200043871 | RR MEDICARE (01) | |
202306000 | (05) | WV |
46439 | MEDCOST (01) | |
4996 | PARTNERS (01) | |
5871109 | AETNA (01) | |
6401643 | (05) | VA |
82321 | BCBS (01) | |
8982321 | (05) | NC |
F41256 | (02) | |
Q36842 | (05) | SC |