Provider Demographics
NPI:1396944831
Name:TEED, RICHARD RUSSELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RUSSELL
Last Name:TEED
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-3780
Mailing Address - Fax:239-343-3781
Practice Address - Street 1:12700 CREEKSIDE LN STE 301
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-343-3780
Practice Address - Fax:239-343-3781
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2025-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116019085208600000X
FLME1181002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012728800Medicaid