Provider Demographics
NPI:1932111879
Name:TEELA, JAMES E (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:TEELA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEW STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2605
Mailing Address - Country:US
Mailing Address - Phone:661-832-1667
Mailing Address - Fax:661-832-2039
Practice Address - Street 1:110 NEW STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2605
Practice Address - Country:US
Practice Address - Phone:661-832-1667
Practice Address - Fax:661-832-2039
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006039218213E00000X
KS12-00378213E00000X
CAE-5178213ES0103X
CAE5178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00399011OtherRAILROAD
CAGRE001390Medicaid
MO37931011OtherBCBS
MO307612804Medicaid
E-5178OtherLICENSE NUMBER
E-5178OtherLICENSE NUMBER
MOX01F155Medicare PIN
MO5929490001Medicare NSC