Provider Demographics
NPI:1760449755
Name:TEEL, DONOVAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:D
Last Name:TEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:680 GUZZI LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5288
Mailing Address - Country:US
Mailing Address - Phone:209-536-3750
Mailing Address - Fax:209-532-9811
Practice Address - Street 1:680 GUZZI LN
Practice Address - Street 2:SUITE 106
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5288
Practice Address - Country:US
Practice Address - Phone:209-536-3750
Practice Address - Fax:209-532-9811
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G308790Medicaid
CA00G308790Medicaid
CAZZZ15313ZMedicare PIN