Provider Demographics
NPI:1194111732
Name:TEDDER, CASE (MD)
Entity type:Individual
Prefix:
First Name:CASE
Middle Name:
Last Name:TEDDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17327 PAGONIA RD STE D
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6009
Mailing Address - Country:US
Mailing Address - Phone:407-905-6000
Mailing Address - Fax:407-636-7848
Practice Address - Street 1:17327 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6009
Practice Address - Country:US
Practice Address - Phone:407-905-6000
Practice Address - Fax:407-636-7848
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN56453207Q00000X
FLME156169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine