Provider Demographics
NPI:1538192232
Name:BLOCK, TERRY N (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:N
Last Name:BLOCK
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 1:1401 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3468
Mailing Address - Country:US
Mailing Address - Phone:701-364-0060
Mailing Address - Fax:701-364-0065
Practice Address - Street 1:1401 13TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3468
Practice Address - Country:US
Practice Address - Phone:701-364-0060
Practice Address - Fax:701-364-0065
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND59602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16448Medicaid
ND726802500Medicaid
ND10284OtherNDBS #
ND28948BLOtherMNBS #
NDHP22978OtherHEALTHPARTNERS #
ND260016371Medicare ID - Type UnspecifiedRR MEDICARE#
ND726802500Medicaid
ND10284Medicare ID - Type UnspecifiedND MEDICARE #