Healthcare Provider Details

I. General information

NPI: 1922920602
Provider Name (Legal Business Name): PATRICK G TEPPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 S OCEAN DR PH 3
HALLANDALE BEACH FL
33009-6627
US

IV. Provider business mailing address

2017 S OCEAN DR PH 3
HALLANDALE BEACH FL
33009-6627
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-0025
  • Fax:
Mailing address:
  • Phone: 305-244-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME182763
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME182763
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME182763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: