=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043223647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE A TEJERO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 MONTGOMERY ST
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-0029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-876-7081
-----------------------------------------------------
Fax | 845-876-7515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29 MONTGOMERY ST
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-0029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-876-7081
-----------------------------------------------------
Fax | 845-876-7515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 113841
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------