1710959762 NPI number — TERRY SCOTT PEERY DO

Table of content: TERRY SCOTT PEERY DO (NPI 1710959762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710959762 NPI number — TERRY SCOTT PEERY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEERY
Provider First Name:
TERRY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710959762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16040 PARK VALLEY DRIVE,
Provider Second Line Business Mailing Address:
BLDG B-100
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-3573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-218-1222
Provider Business Mailing Address Fax Number:
512-218-1393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16040 PARK VALLEY DRIVE,
Provider Second Line Business Practice Location Address:
BLDG B-100
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-3573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-218-1222
Provider Business Practice Location Address Fax Number:
512-218-1393
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084S0012X , with the licence number:  M5436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: M5436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TIN PLUS 095 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 115 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 015 . This is a "TRICARE TC JV LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 197905602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8BC075 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 052 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 197905601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com