Provider Demographics
NPI:1801916630
Name:TERRY, DAVID A (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:TERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6120 W BELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3781
Mailing Address - Country:US
Mailing Address - Phone:623-512-4326
Mailing Address - Fax:623-584-6732
Practice Address - Street 1:6120 W BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3781
Practice Address - Country:US
Practice Address - Phone:623-512-4326
Practice Address - Fax:623-584-6732
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0052232086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ429140Medicaid
Z130196Medicare PIN
AZ429140Medicaid