MEDICARE: DAVID A TEETERS 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	207R00000X	Internal Medicine Physician	54292	MN
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	54292	MN
3	207RP1001X	Pulmonary Disease Physician	54292	MN

General Provider Information

NPI Number	:	1447571187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A TEETERS MD

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	507-284-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 SMITH AVE N STE 501
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2545
Country	:	US
Telephone Number	:	651-726-6200
Fax Number	:	651-726-6201

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	05/24/2022

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