Provider Demographics
NPI:1043422629
Name:TEJERO, ANA INGEBORG (DO)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:INGEBORG
Last Name:TEJERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1136
Mailing Address - Country:US
Mailing Address - Phone:334-262-0342
Mailing Address - Fax:334-262-0390
Practice Address - Street 1:1722 PINE ST STE 309
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-262-0342
Practice Address - Fax:334-262-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1863207R00000X
390200000X
GA069978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20211I3707OtherMEDICARE
GA003136623AMedicaid