Provider Demographics
NPI:1346285590
Name:TEETER, BRIAN H (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:TEETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 N. QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721
Mailing Address - Country:US
Mailing Address - Phone:417-335-7218
Mailing Address - Fax:417-334-1507
Practice Address - Street 1:4302 N. QUAIL RUN RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721
Practice Address - Country:US
Practice Address - Phone:417-230-4810
Practice Address - Fax:417-581-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR5F63207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11428Medicare UPIN