Provider Demographics
NPI:1023325362
Name:TEICHMAN, PETER G (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:TEICHMAN
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 1:2859 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8400
Mailing Address - Country:US
Mailing Address - Phone:541-282-6500
Mailing Address - Fax:541-282-6520
Practice Address - Street 1:2859 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8400
Practice Address - Country:US
Practice Address - Phone:541-282-6500
Practice Address - Fax:541-282-6520
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19719207Q00000X
OR180720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500719117Medicaid
WV5630183000Medicaid