| Doctor Name: | DR. MERRITT BONAR TEDDLIE |
| NPI Number: | 1720427057 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C8467 |
| Business Practice Address: | 7830 Meadow Park Dr 108 Dallas, TX - 752304942 |
| Business Phone Number: | 2144609132 |
| Business Fax Number: | |
| Mailing Address: | 7830 Meadow Park Dr, 108 DALLAS |
| State: | TX |
| Postal Code: | 752304942 |
| Phone Number: | 2144609132 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2013 |
| NPI Last Update Date: | 06/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C8467 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |