Healthcare Provider Details

I. General information

NPI: 1518061142
Provider Name (Legal Business Name): TEOFILO T TECSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-4720
US

IV. Provider business mailing address

PO BOX 711131
CINCINNATI OH
45271-1131
US

V. Phone/Fax

Practice location:
  • Phone: 937-226-3200
  • Fax: 937-226-7863
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35034538T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: