Healthcare Provider Details

I. General information

NPI: 1164545554
Provider Name (Legal Business Name): JAMES WARREN TEAGUE JAMES W. TEAGUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 MIRA VISTA AVE
SANTA BARBARA CA
93103-1747
US

IV. Provider business mailing address

1834 MIRA VISTA AVE
SANTA BARBARA CA
93103-1747
US

V. Phone/Fax

Practice location:
  • Phone: 805-962-3433
  • Fax: 805-962-0804
Mailing address:
  • Phone: 805-962-3433
  • Fax: 805-962-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC26757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: