Provider Demographics
NPI:1811529936
Name:TEGELER, JOSHUA JAY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAY
Last Name:TEGELER
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 1:137 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:DYERSVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52040-1104
Mailing Address - Country:US
Mailing Address - Phone:563-599-2630
Mailing Address - Fax:
Practice Address - Street 1:137 1ST AVE W
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1104
Practice Address - Country:US
Practice Address - Phone:563-599-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program