Individual
DONNA ILENE TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 CITYWEST BLVD STE 300, HOUSTON, TX 77042
(713) 620-4000
(713) 458-4229
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(512) 416-7246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02712
TX
363AM0700X
Medical Physician Assistant
PA02712
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194814301
—
TX
Enumeration date
05/09/2006
Last updated
06/06/2018
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