Provider Demographics
NPI:1639312192
Name:TEBOCKHORST, SETH (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:TEBOCKHORST
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 1:1601 29TH ST. SUITE 1292
Mailing Address - Street 2:#1255
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1010
Mailing Address - Country:US
Mailing Address - Phone:303-900-8946
Mailing Address - Fax:
Practice Address - Street 1:1601 29TH ST. SUITE 1292
Practice Address - Street 2:#1255
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1010
Practice Address - Country:US
Practice Address - Phone:303-900-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21498207XS0106X
COCDRH.0054213207XS0106X, 208200000X, 2086S0105X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand