Provider Demographics
NPI:1851331961
Name:WU, TERESA S (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:620-470-5000
Mailing Address - Fax:602-470-5063
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5651
Practice Address - Fax:602-344-5578
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAA84003207P00000X
FLME0096000207P00000X
AZ42680207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56394OtherBCBS
FL276109200Medicaid
FLP00378353OtherRAILROAD MEDICARE
FL56394OtherBCBS
I23055Medicare UPIN