Provider Demographics
NPI:1629223771
Name:JERRY R. TEEL, PHD PC
Entity Type:Organization
Organization Name:JERRY R. TEEL, PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-659-2902
Mailing Address - Street 1:5401 N PORTLAND AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2121
Mailing Address - Country:US
Mailing Address - Phone:405-659-2902
Mailing Address - Fax:405-951-4901
Practice Address - Street 1:5401 N PORTLAND AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2121
Practice Address - Country:US
Practice Address - Phone:405-659-2902
Practice Address - Fax:405-951-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty