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General NPI Number Information
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NPI Number | 1972716660
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Entity Type | Organization
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Legal Business Name | RENATA TEYTELBAUM, M.D., P.A.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 585 MAIN ST SUITE 101
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City | DUNEDIN
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State | FL
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Zip | 34698-4918
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Country | US
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Telephone | 727-734-6777
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Fax | 727-734-6440
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Provider Business Mailing Address
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Address Line | PO BOX 1228
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City | DUNEDIN
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State | FL
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Zip | 34697-1228
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Country | US
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Telephone | 727-734-6777
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Fax | 727-734-6440
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Authorized Official
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Title or Position | PRESIDENT
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Name | RENATA TEYTELBAUM
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Credential | M.D.
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Telephone | 727-734-6777
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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 | ME56418
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License Number State | FL
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