Provider Demographics
NPI:1063462745
Name:TEEMAN, ERIC D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:TEEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:813-948-3991
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02630213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390410500Medicaid
U69076Medicare UPIN
FL390410500Medicaid
FL5177710001Medicare NSC