Provider Demographics
NPI:1235538174
Name:STEPHEN W. TEAL, MD,FACS, PC
Entity Type:Organization
Organization Name:STEPHEN W. TEAL, MD,FACS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:TEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-434-6695
Mailing Address - Street 1:395 NW VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5427
Mailing Address - Country:US
Mailing Address - Phone:503-434-6695
Mailing Address - Fax:503-434-5372
Practice Address - Street 1:395 NW VALLEY VIEW CT
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5427
Practice Address - Country:US
Practice Address - Phone:503-434-6695
Practice Address - Fax:503-434-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC93918Medicare UPIN