Provider Demographics
NPI:1831205525
Name:COON, TERESA L (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:COON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1895
Mailing Address - Country:US
Mailing Address - Phone:641-236-7524
Mailing Address - Fax:641-236-7944
Practice Address - Street 1:1004 STATE ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4856
Practice Address - Country:US
Practice Address - Phone:563-359-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32230207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00742669OtherRAILROAD MEDICARE
IAP00742669OtherRAILROAD MEDICARE
IAI16084Medicare PIN