Provider Demographics
NPI:1134139777
Name:TEPLIN, LAWRENCE ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALAN
Last Name:TEPLIN
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 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:
Practice Address - Street 1:909 SAN RAMON VALLEY BLVD
Practice Address - Street 2:STE. 118
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4038
Practice Address - Country:US
Practice Address - Phone:925-362-1080
Practice Address - Fax:925-362-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1397213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E13920Medicaid
CA000E13920Medicaid
CA0654360001Medicare NSC
T10937Medicare UPIN