MEDICARE: GREGORY M 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
1	207Q00000X	Family Medicine Physician	H0887	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01337849	OTHER	TX	RR MEDICARE
6	P00937540	OTHER	TX	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CR000	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0045KC	OTHER	TX	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1972501773	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972501773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY M TERRY M.D.,

Provider Business Mailing Address
First Line	:	2610 N ALEXANDER DR
Second Line	:	SUITE 201
City	:	BAYTOWN
State	:	TX
Zip	:	77520-3368
Country	:	US
Telephone Number	:	281-428-4411
Fax Number	:	281-428-4384

Provider Business Practice Location Address
First Line	:	2610 N ALEXANDER DR
Second Line	:	SUITE 201
City	:	BAYTOWN
State	:	TX
Zip	:	77520-3368
Country	:	US
Telephone Number	:	281-428-4411
Fax Number	:	281-428-4384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/21/2016

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