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General NPI Number Information
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NPI Number | 1407815558
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Entity Type | Individual
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Provider Name | TEAGUE DOMBECK MD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 111 17TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5273
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Country | US
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Telephone | 320-762-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 111 17TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-5273
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Country | US
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Telephone | 320-762-1511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 47497
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License Number State | MN
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