Healthcare Provider Details

I. General information

NPI: 1629028410
Provider Name (Legal Business Name): TERENCE ANTHONY ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 W MCDOWELL RD SUITE 102
AVONDALE AZ
85392-4901
US

IV. Provider business mailing address

PO BOX 271429
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7614
  • Fax: 623-846-0993
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number27628
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number29782
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number51325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: