Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 35-061329 | OH |
NPI | 1255441622 |
---|---|
Provider Name | Thomas Leslie Teater |
First Address | Dover, OH 44622-2058 |
Second Address | Dover, OH 44622-2058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 24/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0979393 | (05) | OH |
F65001 | (02) |