Provider Demographics
NPI:1871514729
Name:TEACHER, THEODORE M (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:M
Last Name:TEACHER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26691 PLAZA
Mailing Address - Street 2:SUITE 235
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6329
Mailing Address - Country:US
Mailing Address - Phone:949-364-9054
Mailing Address - Fax:949-364-6171
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:SUITE 235
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6329
Practice Address - Country:US
Practice Address - Phone:949-364-9054
Practice Address - Fax:949-364-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2024-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG458982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57376ZOtherBLUE SHIELD
CAZZZ57376ZOtherBLUE SHIELD
CAWG45898AMedicare PIN