Basic Information
Provider Information
NPI: 1619950516
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TEUBER
FirstName: SUZANNE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 451 HEALTH SCIENCES DRIVE
Address2: SUITE 6510
City: DAVIS
State: CA
PostalCode: 956168660
CountryCode: US
TelephoneNumber: 5307522884
FaxNumber: 5307546047
Practice Location
Address1: 451 HEALTH SCIENCES DRIVE
Address2: SUITE 6510
City: DAVIS
State: CA
PostalCode: 956168660
CountryCode: US
TelephoneNumber: 5307522884
FaxNumber: 5307546047
Other Information
ProviderEnumerationDate: 11/23/2005
LastUpdateDate: 04/04/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RA0201XG65699CAY Allopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology

No ID Information.


Home