Individual
CAROL C TEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3850 MONTLAKE BLVD NE RM 148 B, ARENA/HEC EDMUNDSON PAVILLION, SEATTLE, WA 98195-0001
(206) 543-1552
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD00014585
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
MD00014585
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232044
L&I
—
01
—
0390
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
1851476675
—
WA
Enumeration date
10/27/2006
Last updated
09/28/2011
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