Physician Compare National (NPI:1801060389)

HEALTHCARE PROVIDER: DR. THEODORE MALTEZOS

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1801060389
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789736612
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090723000323
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MALTEZOS
	Individual professional last name
Provider First Name	THEODORE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4851 LEGACY DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 307
	Group Practice or individual's line 2 address
City	FRISCO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	750340853
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y