Healthcare Provider Details

I. General information

NPI: 1174824544
Provider Name (Legal Business Name): LAWRENCE A TEPLIN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SAN RAMON VALLEY BLVD SUITE #118
DANVILLE CA
94526-4038
US

IV. Provider business mailing address

909 SAN RAMON VALLEY BLVD SUITE #118
DANVILLE CA
94526-4038
US

V. Phone/Fax

Practice location:
  • Phone: 925-362-1080
  • Fax: 925-362-1083
Mailing address:
  • Phone: 925-362-1080
  • Fax: 925-362-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1397
License Number StateCA

VIII. Authorized Official

Name: LAWRENCE A TEPLIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 925-362-1080