Provider Demographics
NPI:1609288984
Name:TEUFEL, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:TEUFEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 E JOYCE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5257
Mailing Address - Country:US
Mailing Address - Phone:479-935-3378
Mailing Address - Fax:479-935-3361
Practice Address - Street 1:1794 E JOYCE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-935-3378
Practice Address - Fax:479-935-3361
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR274213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230354717Medicaid