Provider Demographics
NPI:1174771083
Name:TEO, ALAN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:TEO
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 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-6176
Mailing Address - Fax:503-494-6152
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:700 KMS PLACE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-6176
Practice Address - Fax:503-494-6152
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010981022084A0401X, 2084P0800X
CAA1049772084P0800X
ORMD1963272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine