Provider Demographics
NPI:1285839787
Name:OEY-TRUDEAU, THERESA (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OEY-TRUDEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:DALE HONG GWAT
Other - Last Name:OEY-DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2474
Mailing Address - Country:US
Mailing Address - Phone:605-696-2700
Mailing Address - Fax:605-697-6939
Practice Address - Street 1:400 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2497
Practice Address - Country:US
Practice Address - Phone:605-697-9500
Practice Address - Fax:605-697-6939
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8556OtherSTATE LICENSE