Provider Demographics
NPI:1992727135
Name:TEDFORD, DENNIS DUANE (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DUANE
Last Name:TEDFORD
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 1:3411 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2438
Mailing Address - Country:US
Mailing Address - Phone:806-796-0507
Mailing Address - Fax:806-799-6908
Practice Address - Street 1:703 E FELT ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3439
Practice Address - Country:US
Practice Address - Phone:806-637-1955
Practice Address - Fax:806-637-2169
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3632207Q00000X, 207P00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037656802Medicaid
TX100261100OtherFIRSTCARE PRO-FEE
TX8A8612OtherBCBS
TX126913601OtherTPI
TXJ3632OtherTEXAS LICENSE NUMBER
TXJ3632OtherTEXAS LICENSE NUMBER
TX00K31WMedicare PIN