Individual
ROBERT DOUGLAS TEASDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-8018
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-8018
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
36840
NC
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
36840
NC
207XX0801X
Orthopaedic Trauma Physician
36840
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200043871
RR MEDICARE
—
05
—
202306000
—
WV
01
—
46439
MEDCOST
—
01
—
4996
PARTNERS
—
01
—
5871109
AETNA
—
05
—
6401643
—
VA
01
—
82321
BCBS
—
05
—
8982321
—
NC
05
—
Q36842
—
SC
Enumeration date
11/30/2005
Last updated
11/15/2010
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