Provider Demographics
NPI:1891798146
Name:TEPPER, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TEPPER
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 1:5030 J ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3800
Mailing Address - Country:US
Mailing Address - Phone:916-455-1155
Mailing Address - Fax:916-455-1195
Practice Address - Street 1:5030 J ST
Practice Address - Street 2:STE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3800
Practice Address - Country:US
Practice Address - Phone:916-455-1155
Practice Address - Fax:916-455-1195
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2023-03-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAA77012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA77012OtherLICENSE
CA460517131OtherTAX ID
CA00A770120Medicare ID - Type UnspecifiedMEDICARE
CAA77012OtherLICENSE