Provider Demographics
NPI:1780639021
Name:TEAGUE, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E CENTRAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2778
Mailing Address - Country:US
Mailing Address - Phone:423-907-1740
Mailing Address - Fax:423-907-1743
Practice Address - Street 1:919 E CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2778
Practice Address - Country:US
Practice Address - Phone:423-907-1740
Practice Address - Fax:423-907-1743
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD33973207RC0000X
TNMD0000033973207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523025Medicaid
TN060057805OtherRAILROAD MEDICARE
C86723Medicare UPIN
TNC86723Medicare UPIN
TN3850220Medicare PIN
TN38502202Medicare PIN