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NPI Code Detail

MEDICARE: DAVID CROCKETT TELLER MD

MEDICARE: DAVID CROCKETT TELLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YS0123XFacial Plastic Surgery PhysicianH2828TX

General Provider Information

NPI Number : 1154300788
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID CROCKETT TELLER MD
Provider Business Mailing Address
First Line : 7901 METROPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 512-823-4880
Fax Number : 512-823-4155
Provider Business Practice Location Address
First Line : 7901 METROPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 512-823-4880
Fax Number : 512-823-4155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 12/15/2016

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Directions to “ DAVID CROCKETT TELLER MD” Practice Location

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