Individual
MICHAEL JOSEPH TEBALT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
298 MEMORIAL DR, SENECA, SC 29672-9443
(864) 885-7532
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25822
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258223
—
SC
05
—
GP2991
—
SC
Enumeration date
09/05/2006
Last updated
06/25/2015
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