Provider Demographics
NPI:1164545554
Name:TEAGUE, JAMES WARREN (JAMES W TEAGUE MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:JAMES W TEAGUE MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 MIRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-1747
Mailing Address - Country:US
Mailing Address - Phone:805-962-3433
Mailing Address - Fax:805-962-0804
Practice Address - Street 1:1834 MIRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-1747
Practice Address - Country:US
Practice Address - Phone:805-962-3433
Practice Address - Fax:805-962-0804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC267572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C267570Medicare ID - Type Unspecified
CAA87106Medicare UPIN