Provider Demographics
NPI:1053511105
Name:ERIC D TEEMAN, DPM, PA
Entity Type:Organization
Organization Name:ERIC D TEEMAN, DPM, PA
Other - Org Name:MOBILE PODIATRY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:TEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-948-3991
Mailing Address - Street 1:PO BOX 341873
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-1873
Mailing Address - Country:US
Mailing Address - Phone:813-210-3338
Mailing Address - Fax:813-948-0500
Practice Address - Street 1:19802 WELLINGTON MANOR BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5012
Practice Address - Country:US
Practice Address - Phone:813-948-3991
Practice Address - Fax:813-948-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390410500Medicaid
FL65521AMedicare PIN
FLU69076Medicare UPIN
FL390410500Medicaid