Provider Demographics
NPI:1437112901
Name:PLATT, TERESA L (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:PLATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SIPPRELLE DR
Mailing Address - Street 2:
Mailing Address - City:PARACHUTE
Mailing Address - State:CO
Mailing Address - Zip Code:81635-9213
Mailing Address - Country:US
Mailing Address - Phone:970-285-7046
Mailing Address - Fax:970-285-6064
Practice Address - Street 1:73 SIPPRELLE DR
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9213
Practice Address - Country:US
Practice Address - Phone:970-285-7046
Practice Address - Fax:970-285-6064
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01261726Medicaid
CO80245Medicare ID - Type Unspecified
CO01261726Medicaid
COC72841Medicare ID - Type Unspecified