Individual
DR. OTTO H.P. TEIXEIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 N STATE OF FRANKLIN RD., GROUND FLOOR, JOHNSON CITY, TN 37604-6062
(423) 439-7320
(423) 439-7343
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-7320
(423) 439-7343
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
34692
TN
2080P0202X
Pediatric Cardiology Physician
Primary
034692
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3714470
GROUP MEDICARE #
TN
Enumeration date
09/12/2005
Last updated
02/15/2012
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