Provider Demographics
NPI:1821064486
Name:TEAGUE, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
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:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-580-1584
Practice Address - Street 1:1323 E. FRANKLIN ST.
Practice Address - Street 2:SUITE 105
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645
Practice Address - Country:US
Practice Address - Phone:254-582-7481
Practice Address - Fax:254-580-1584
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117845101Medicaid
TX8301J1Medicare ID - Type Unspecified
TX117845101Medicaid