Provider Demographics
NPI:1922062116
Name:TEICHGRAEBER, JOHN FLYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FLYNN
Last Name:TEICHGRAEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 5.254
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-7300
Mailing Address - Fax:713-500-7296
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7234
Practice Address - Fax:713-512-2221
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4061207YS0123X, 207YX0007X, 2082S0099X, 2086S0120X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134549808Medicaid
TX134549805Medicaid
TX134549803OtherCSHCN
TX81Z234OtherBCBSTX
TXB26899Medicare UPIN
TX340005635Medicare PIN
TX134549808Medicaid
TX134549805Medicaid