Provider Demographics
NPI:1629160700
Name:TEETER, CARMELITA A (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:A
Last Name:TEETER
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 1:6750 N MACARTHUR BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2469
Mailing Address - Country:US
Mailing Address - Phone:214-496-9700
Mailing Address - Fax:214-496-9707
Practice Address - Street 1:1601 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8910
Practice Address - Country:US
Practice Address - Phone:956-421-2663
Practice Address - Fax:956-421-2418
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4143207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161080001Medicaid
TX8J8890OtherBLUE CROSS BLUE SHIELD
TX8A8739Medicare PIN
TX8J8890OtherBLUE CROSS BLUE SHIELD
TX161080001Medicaid