Provider Demographics
NPI:1154363620
Name:TEEL, DUDLEY GARDNER (MD)
Entity type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:GARDNER
Last Name:TEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 16TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-2369
Mailing Address - Country:US
Mailing Address - Phone:772-567-8380
Mailing Address - Fax:772-564-7823
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:772-563-4440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044584207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL695629Medicaid
FL695629Medicaid
FLAT2786967OtherDEA
FL94339AMedicare ID - Type Unspecified