Provider Demographics
NPI:1871941880
Name:TEGGE, GARY DWAYNE
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DWAYNE
Last Name:TEGGE
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 1:616 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1335
Mailing Address - Country:US
Mailing Address - Phone:989-817-6234
Mailing Address - Fax:
Practice Address - Street 1:616 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1335
Practice Address - Country:US
Practice Address - Phone:989-817-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other