Provider Demographics
NPI:1902896954
Name:TERRILL, RONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:TERRILL
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 1:503 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:STATE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50247-7719
Mailing Address - Country:US
Mailing Address - Phone:641-483-2141
Mailing Address - Fax:641-483-2148
Practice Address - Street 1:503 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:STATE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50247-7719
Practice Address - Country:US
Practice Address - Phone:641-483-2141
Practice Address - Fax:641-483-2148
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19320207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39922OtherBLUE SHIELD OF IA
IA0685214Medicaid
IAI15809Medicare PIN
IAA14385Medicare UPIN