Healthcare Provider Details

I. General information

NPI: 1427015726
Provider Name (Legal Business Name): TEODORO C. VARGAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 EUREKA RD
EUREKA MO
63025-2173
US

IV. Provider business mailing address

1075 EUREKA RD
EUREKA MO
63025-2173
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-9960
  • Fax: 636-938-9961
Mailing address:
  • Phone: 636-938-9960
  • Fax: 636-938-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: