Provider Demographics
NPI:1518233055
Name:TERRY, KRISTOPHER SCOT (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:SCOT
Last Name:TERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 PACIFIC AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1498 PACIFIC AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4208
Practice Address - Country:US
Practice Address - Phone:855-768-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO173762207R00000X
MTMED-PHYS-LIC-41922207R00000X
WAOP60558268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine