Provider Demographics
NPI:1578344180
Name:TEAL, GARY EDWARD (LAC, NMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDWARD
Last Name:TEAL
Suffix:
Gender:M
Credentials:LAC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 S 1410 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2265
Mailing Address - Country:US
Mailing Address - Phone:801-669-7766
Mailing Address - Fax:385-300-7777
Practice Address - Street 1:1389 CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7660
Practice Address - Country:US
Practice Address - Phone:385-220-5000
Practice Address - Fax:385-300-7777
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT312427-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist