Provider Demographics
NPI:1033281241
Name:TEEGARDEN, ERNEST A (DO)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:A
Last Name:TEEGARDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 REMCON CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1642
Mailing Address - Country:US
Mailing Address - Phone:915-532-3600
Mailing Address - Fax:915-532-8999
Practice Address - Street 1:7300 REMCON CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1642
Practice Address - Country:US
Practice Address - Phone:915-532-3600
Practice Address - Fax:915-532-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3127207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01696897OtherRR
TX133035902Medicaid
TX133035911Medicaid
TX8FX659OtherBCBS
TX133035912Medicaid
TX00J49KMedicare PIN
TX344224YK6UMedicare PIN
TX8FX659OtherBCBS