Provider Demographics
NPI:1316985047
Name:TENG, LI RAY (MD)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:RAY
Last Name:TENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W. HEBRON PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-426-8675
Mailing Address - Fax:972-492-4694
Practice Address - Street 1:1601 W. HEBRON PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-426-8675
Practice Address - Fax:972-492-4694
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099057403Medicaid
TX112874603OtherMEDICAID GROUP NUMBER
TX00U61EOtherMEDICARE GROUP NUMBER
TX099057402Medicaid
TX099057404OtherMEDICAID OTHER
TX110135210OtherRAILROAD MEDICARE
TX110135210OtherRAILROAD MEDICARE
TX099057404OtherMEDICAID OTHER
TX8L4063Medicare PIN