MEDICARE: LARRY L TEUBER M.D.

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	207T00000X	Neurological Surgery Physician	3403	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3403	OTHER	SD	DAKOTACARE PIN
4	0002709	OTHER	SD	WELLMARK BCBS PIN
5	1477512036	OTHER	SD	NPI

General Provider Information

NPI Number	:	1477512036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY L TEUBER M.D.

Provider Business Mailing Address
First Line	:	9701 CLARKSON RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9100
Country	:	US
Telephone Number	:	605-484-1616
Fax Number	:	605-394-9307

Provider Business Practice Location Address
First Line	:	9701 CLARKSON RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9100
Country	:	US
Telephone Number	:	605-484-1616
Fax Number	:	605-394-9307

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	11/07/2012

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