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NPI Code Detail

MEDICARE: MR. JARED GIFFORD TETER AU.D., F-AAA

MEDICARE:  MR. JARED GIFFORD TETER  AU.D., F-AAA
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
1231H00000XAudiologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111454844OTHERNYCAQH PROVIDER ID NUMBER

General Provider Information

NPI Number : 1912021312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JARED GIFFORD TETER AU.D., F-AAA
Provider Business Mailing Address
First Line : 18 HAWKES TRL
Second Line :
City : WEBSTER
State : NY
Zip : 14580-4211
Country : US
Telephone Number : 585-672-5761
Fax Number : 585-244-7126
Provider Business Practice Location Address
First Line : 2234 N WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-6940
Country : US
Telephone Number : 719-632-2376
Fax Number : 719-633-2327
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 01/29/2021

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Directions to “ MR. JARED GIFFORD TETER AU.D., F-AAA” Practice Location

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