Healthcare Provider Details

I. General information

NPI: 1740287325
Provider Name (Legal Business Name): TERRY ELLIOT PASSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/19/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GREENO RD N STE D2
FAIRHOPE AL
36532-3057
US

IV. Provider business mailing address

208 GREENO RD N STE D2
FAIRHOPE AL
36532-3057
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-4750
  • Fax: 251-990-2560
Mailing address:
  • Phone: 251-928-4750
  • Fax: 251-990-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number18468
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: