Provider Demographics
NPI:1679510531
Name:TEAGUE, DOUGLAS (RDMS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3014
Mailing Address - Country:US
Mailing Address - Phone:718-963-0404
Mailing Address - Fax:
Practice Address - Street 1:7606 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3321
Practice Address - Country:US
Practice Address - Phone:718-492-6590
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography