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NPI Code Detail

MEDICARE: TERRA CORLEY

MEDICARE: TERRA CORLEY
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
12086S0129XVascular Surgery Physician200970OK

General Provider Information

NPI Number : 1871184895
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRA CORLEY
Provider Business Mailing Address
First Line : 3200 QUAIL SPRINGS PKWY STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2699
Country : US
Telephone Number : 405-241-3791
Fax Number : 405-241-0998
Provider Business Practice Location Address
First Line : 3200 QUAIL SPRINGS PKWY STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2699
Country : US
Telephone Number : 405-241-3791
Fax Number : 405-241-0998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2021
Last Update Date : 02/02/2021

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Directions to “ TERRA CORLEY ” Practice Location

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