Healthcare Provider Details

I. General information

NPI: 1285334169
Provider Name (Legal Business Name): ALEXANDER JEFFORY TEAGUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY ML 0558
CINCINNATI OH
45267-3618
US

IV. Provider business mailing address

231 ALBERT SABIN WAY MAIL LOCATION: 0558
CINCINNATI OH
45267-0558
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4748
  • Fax:
Mailing address:
  • Phone: 630-930-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.156220
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: