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General NPI Number Information
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NPI Number | 1962463091
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Entity Type | Individual
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Provider Name | MICHAEL TEDDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 333 RED WOLF BLVD
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City | JONESBORO
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State | AR
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Zip | 72405
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Country | US
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Telephone | 870-972-8181
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Fax | 870-933-1824
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Provider Business Mailing Address
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Address Line | PO BOX 1331
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City | JONESBORO
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State | AR
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Zip | 72403
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Country | US
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Telephone | 870-932-7024
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Fax | 870-930-9377
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C-4865
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License Number State | AR
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