Healthcare Provider Details

I. General information

NPI: 1629067178
Provider Name (Legal Business Name): CHARLES TEEBAGY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N FEDERAL HWY #110
POMPANO BEACH FL
33062-1095
US

IV. Provider business mailing address

7800 SW 87TH AVE SUITE C-350
MIAMI FL
33173-2539
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-5731
  • Fax: 954-941-2706
Mailing address:
  • Phone: 954-731-9676
  • Fax: 954-731-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME13828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: