Provider Demographics
NPI:1487647632
Name:TEEL, ALFONZA (RPA-C)
Entity Type:Individual
Prefix:
First Name:ALFONZA
Middle Name:
Last Name:TEEL
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:3100 DURALEIGH RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8105
Practice Address - Country:US
Practice Address - Phone:919-788-8797
Practice Address - Fax:919-313-1276
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003624207X00000X
NC0010-06410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P334556OtherOXFORD
003624OtherAETNA
P334556OtherOXFORD
Q10085Medicare UPIN