Provider Demographics
NPI:1982675104
Name:TEFF, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:TEFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 SILVER CLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-9258
Mailing Address - Country:US
Mailing Address - Phone:614-598-7462
Mailing Address - Fax:
Practice Address - Street 1:1401 25TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5183
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:406-731-8318
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60072193207T00000X
TXN2836207T00000X
CO47423207T00000X
ND12668207T00000X
NE205073207T00000X
OR166883207T00000X
NM2009-0013207T00000X
MN60122207T00000X
MO106073207T00000X
WY9154A207T00000X
AZ51781207T00000X
MT11733207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011001755Medicare PIN
COCOA105907Medicare PIN
MT011001754Medicare PIN
MO152360071Medicare PIN