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NPI Code Detail

MEDICARE: DANIEL PAUL TELLER PA-C

MEDICARE: DANIEL PAUL TELLER PA-C
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
1363AM0700XMedical Physician Assistant5601001590MI
2363A00000XPhysician AssistantPA9109236FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407982366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL PAUL TELLER PA-C
Provider Business Mailing Address
First Line : 1995 E OAKLAND PARK BLVD STE 310
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33306-1138
Country : US
Telephone Number : 954-791-6146
Fax Number : 954-337-2733
Provider Business Practice Location Address
First Line : 1995 E OAKLAND PARK BLVD STE 310
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33306-1138
Country : US
Telephone Number : 954-791-6146
Fax Number : 954-337-2733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 05/05/2020

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Practice Location Address:
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1477994325 — ZACHARY THOMAS PA-C
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33306-1138
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Practice Fax:
1811392616 — ASHLEY SCONZO PA
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FORT LAUDERDALE, FL
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Practice Location Address:
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1417321894 — MR. TREVOR ALLEN KOLSKI PA-C
Practice Location Address:
1995 E OAKLAND PARK BLVD STE 310
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33306-1138
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Practice Fax:

Directions to “ DANIEL PAUL TELLER PA-C” Practice Location

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