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NPI Code Detail

MEDICARE: DR. PHILIP JON TERRY M.D.

MEDICARE: DR. PHILIP JON TERRY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianE-8316AR
2207Q00000XFamily Medicine PhysicianE-8316AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225391428
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP JON TERRY M.D.
Provider Business Mailing Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 479-443-4301
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 479-443-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2012
Last Update Date : 04/10/2026

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