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General NPI Number Information
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NPI Number | 1932316296
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Entity Type | Organization
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Legal Business Name | TIMOTHY W TESLOW, M.D., P.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 1275 SADLER WAY SUITE 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-3175
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Country | US
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Telephone | 907-457-7874
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Fax | 907-457-7060
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Provider Business Mailing Address
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Address Line | 1275 SADLER WAY SUITE 102
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City | FAIRBANKS
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State | AK
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Zip | 99701-3175
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Country | US
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Telephone | 907-457-7874
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Fax | 907-457-7060
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY W TESLOW
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Credential | M.D.
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Telephone | 907-457-7874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 3579
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License Number State | AK
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