=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528125978
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA N. UNDERWOOD MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 E 5TH ST STE 328
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63090-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-239-1101
-----------------------------------------------------
Fax | 636-239-0250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 776084
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60677-6084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-239-1101
-----------------------------------------------------
Fax | 636-239-0250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 2024040685
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------