Individual
JENNIFER MARIE TEETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1220 SPRING ST, JEFFERSONVILLE, IN 47130-3704
(812) 282-8494
(812) 288-4481
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 559-9337
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02005701A
IN
207Q00000X
Family Medicine Physician
250143
NY
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02005701A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
250143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196290270
MEDICARE
IN
05
—
300034743
—
IN
Enumeration date
06/02/2010
Last updated
04/05/2024
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