Individual
STANLEY DANE TEETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 SKYLINE DR, RUSSELLVILLE, AR 72801-3363
(479) 968-2345
(479) 890-2467
Mailing address
101 SKYLINE DR, RUSSELLVILLE, AR 72801-3363
(479) 968-2345
(479) 890-2467
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-3080
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103868001
—
AR
Enumeration date
11/23/2010
Last updated
09/30/2014
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