Provider Demographics
NPI:1124157235
Name:J. TEIG PORT, M.D., P.A.
Entity type:Organization
Organization Name:J. TEIG PORT, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:TEIG
Authorized Official - Last Name:PORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-288-3331
Mailing Address - Street 1:2822 N BELT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9321
Mailing Address - Country:US
Mailing Address - Phone:972-288-3331
Mailing Address - Fax:972-288-3340
Practice Address - Street 1:2822 N BELT LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9321
Practice Address - Country:US
Practice Address - Phone:972-288-3331
Practice Address - Fax:972-288-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151832601Medicaid
TXDA3112OtherPALMETTO GBA
TX6169530001Medicare NSC
TX151832601Medicaid