Provider Demographics
NPI:1336513712
Name:TEUMER, JOHN R
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:TEUMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 OTERO AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9103
Mailing Address - Country:US
Mailing Address - Phone:970-556-4014
Mailing Address - Fax:
Practice Address - Street 1:5100 OTERO AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9103
Practice Address - Country:US
Practice Address - Phone:970-556-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36233536OtherMEDICAID ID PROVIDER #