Provider Demographics
NPI:1861461709
Name:TEERMANN, GABRIELE EMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELE
Middle Name:EMMA
Last Name:TEERMANN
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 1:1820 E 17TH STREET
Mailing Address - Street 2:STE 230
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6521
Mailing Address - Country:US
Mailing Address - Phone:208-529-9779
Mailing Address - Fax:208-542-2756
Practice Address - Street 1:3100 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7533
Practice Address - Country:US
Practice Address - Phone:208-529-6048
Practice Address - Fax:208-529-7085
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086120207ZP0102X
IDM10187207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4010167583OtherREGENCE BLUE SHIELD OF IDAHO
ID808087700Medicaid
ID77343OtherBLUE CROSS OF IDAHO
ID808087700Medicaid