Provider Demographics
NPI:1013949049
Name:TEASDALE, ROBERT DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:TEASDALE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1375 S ELISEO DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2013
Mailing Address - Country:US
Mailing Address - Phone:415-461-4150
Mailing Address - Fax:415-461-4150
Practice Address - Street 1:1375 S ELISEO DR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2013
Practice Address - Country:US
Practice Address - Phone:415-461-4150
Practice Address - Fax:415-461-4150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33292207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3905820001Medicare NSC
CAA45494Medicare UPIN