Provider Demographics
NPI:1285673814
Name:TERUEL, JUAN JOSE (DO)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:TERUEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W WADE HAMPTON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1311
Mailing Address - Country:US
Mailing Address - Phone:864-655-6615
Mailing Address - Fax:855-617-4423
Practice Address - Street 1:805 W WADE HAMPTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1311
Practice Address - Country:US
Practice Address - Phone:864-655-6615
Practice Address - Fax:855-617-4423
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC8271L064OtherMEDICARE
SC005345Medicaid
SC005345Medicaid
SCG34253Medicare UPIN
SC0632215OtherCIGNA ID
SC5999480OtherAETNA ID
SCG34253Medicare UPIN
G342537951Medicare PIN