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General NPI Number Information
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NPI Number | 1629068465
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Entity Type | Individual
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Provider Name | SCOT ALAN TEBO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT# 15245; BLDG 3031
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City | APO
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State | AP
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Zip | 96271
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Country | US
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Telephone | 315-737-1857
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 400 BOX 8643
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City | APO
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State | AP
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Zip | 96273-0087
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Country | US
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Telephone | 108-379-0769
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD-13366
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD-13366
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License Number State | HI
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