Provider Demographics
NPI:1467446997
Name:TEHENG, RAYMUNDO V (MD)
Entity type:Individual
Prefix:
First Name:RAYMUNDO
Middle Name:V
Last Name:TEHENG
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 1:200 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1659
Mailing Address - Country:US
Mailing Address - Phone:912-739-2509
Mailing Address - Fax:912-739-4989
Practice Address - Street 1:602 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-5914
Practice Address - Country:US
Practice Address - Phone:912-739-2509
Practice Address - Fax:912-739-4989
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021208207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A01330Medicare UPIN
GA16BDFRBMedicare PIN