Provider Demographics
NPI:1144459652
Name:TERRY, TEKESHA LASHALL (IDMT)
Entity type:Individual
Prefix:
First Name:TEKESHA
Middle Name:LASHALL
Last Name:TERRY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31ST MEDICAL GROUP
Mailing Address - Street 2:UNIT 6180 BOX 245
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09604-0245
Mailing Address - Country:US
Mailing Address - Phone:0113943-430-5692
Mailing Address - Fax:
Practice Address - Street 1:31ST MEDICAL GROUP
Practice Address - Street 2:UNIT 6180 BOX 245
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604-0245
Practice Address - Country:US
Practice Address - Phone:0113943-430-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman