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Individual
JON C TEACLE
Active
Individual
JON C TEACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02372
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190253801
—
TX
01
—
8Y2631
BCBSTX
TX
Enumeration date
03/14/2006
Last updated
08/12/2015
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