Provider Demographics
NPI:1346493491
Name:DAVID TEICHEIRA MD PC
Entity Type:Organization
Organization Name:DAVID TEICHEIRA MD PC
Other - Org Name:DAVID TEICHEIRA, MD, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TEICHEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-923-0900
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-0207
Mailing Address - Country:US
Mailing Address - Phone:530-923-0900
Mailing Address - Fax:530-923-0901
Practice Address - Street 1:730 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3847
Practice Address - Country:US
Practice Address - Phone:916-923-0900
Practice Address - Fax:916-923-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-02
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60747208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BQ239OtherMEDICARE PTAN
BQ239OtherMEDICARE PTAN