Provider Demographics
NPI:1972558039
Name:TERUEL, MARK ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:TERUEL
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 1:3351 EASTBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5744
Mailing Address - Country:US
Mailing Address - Phone:970-493-7733
Mailing Address - Fax:970-493-8745
Practice Address - Street 1:3351 EASTBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:970-493-7733
Practice Address - Fax:970-493-8745
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44625207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20231351Medicaid
COI04611Medicare UPIN
COC805548Medicare PIN