Healthcare Provider Details

I. General information

NPI: 1023579927
Provider Name (Legal Business Name): TERRENCE ANIL PRASAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N 91ST AVE STE I
PEORIA AZ
85381-3692
US

IV. Provider business mailing address

13943 N 91ST AVE STE I
PEORIA AZ
85381-3692
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2690
  • Fax: 623-815-2689
Mailing address:
  • Phone: 623-815-2690
  • Fax: 623-815-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2022025164
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number011020
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: