Healthcare Provider Details

I. General information

NPI: 1487643177
Provider Name (Legal Business Name): DR. JULIO TEIXEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSBORNE ST
DANBURY CT
06810-6000
US

IV. Provider business mailing address

24 HOSPITAL AVE
DANBURY CT
06810-6077
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7131
  • Fax:
Mailing address:
  • Phone: 203-739-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number207284
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number73025
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: