Provider Demographics
NPI:1265587224
Name:ETTEN, TERESA T (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:T
Last Name:ETTEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-788-6657
Mailing Address - Fax:303-788-8837
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-788-6657
Practice Address - Fax:303-788-8837
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-02-01
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Provider Licenses
StateLicense IDTaxonomies
CO40631174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76185273Medicaid
CO160059141OtherRAILROAD MEDICARE
CO446182YTU0Medicare PIN
COH73009Medicare UPIN
CO76185273Medicaid