Individual
MR. ANTONIO TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
143 S 63RD ST STE 100, MESA, AZ 85206-1623
(480) 835-6100
(480) 461-4243
Mailing address
6343 E MAIN ST STE 12, MESA, AZ 85205-8955
(480) 835-6100
(480) 461-4243
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10813
AZ
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
02/23/2026
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