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General NPI Number Information
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NPI Number | 1851769152
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Entity Type | Individual
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Provider Name | TEAGUE GEARHART D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 1155 KELLY JOHNSON BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3932
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Country | US
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Telephone | 719-574-9800
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Fax | 719-574-9749
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Provider Business Mailing Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-801-5656
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | EL6742
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License Number State | CA
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