MEDICARE: DAVID K TEEGARDEN 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
1	207RG0100X	Gastroenterology Physician	D8453	TX

General Provider Information

NPI Number	:	1255307005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID K TEEGARDEN MD

Provider Business Mailing Address
First Line	:	PO BOX 5500
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75712-5500
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:	903-593-7852

Provider Business Practice Location Address
First Line	:	910 E HOUSTON
Second Line	:	STE 5500
City	:	TYLER
State	:	TX
Zip	:	75702
Country	:	US
Telephone Number	:	903-531-4395
Fax Number	:	903-597-2314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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