Provider Demographics
NPI:1154038420
Name:ERIC TEPPER, MD
Entity type:Organization
Organization Name:ERIC TEPPER, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-455-1155
Mailing Address - Street 1:5030 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3751
Mailing Address - Country:US
Mailing Address - Phone:916-455-1155
Mailing Address - Fax:
Practice Address - Street 1:5030 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3751
Practice Address - Country:US
Practice Address - Phone:916-455-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty