Doctor Name: | LEAH TEDDER |
NPI Number: | 1093045569 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 9105931 |
Business Practice Address: | 2190 Highway 85 N Niceville, FL - 325781045 |
Business Phone Number: | 8507299490 |
Business Fax Number: | |
Mailing Address: | 4242 Jade Loop, DESTIN |
State: | FL |
Postal Code: | 325415134 |
Phone Number: | 8085547640 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2010 |
NPI Last Update Date: | 03/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 9105931 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |