Provider Demographics
NPI:1922292481
Name:JOSEPH D TE MD PC
Entity Type:Organization
Organization Name:JOSEPH D TE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DERIT
Authorized Official - Last Name:TE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-628-9298
Mailing Address - Street 1:162 E 300 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3653
Mailing Address - Country:US
Mailing Address - Phone:435-628-9298
Mailing Address - Fax:435-628-9655
Practice Address - Street 1:162 S 300 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-628-9298
Practice Address - Fax:435-628-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3705341205261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5531560001Medicare NSC
UT000058019Medicare PIN
UTH02819Medicare UPIN