Healthcare Provider Details

I. General information

NPI: 1235240847
Provider Name (Legal Business Name): DAVID J TERRY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 CROSSINGS DR STE A
PRESCOTT AZ
86305-7150
US

IV. Provider business mailing address

3605 CROSSINGS DR STE A
PRESCOTT AZ
86305-7150
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-5679
  • Fax: 928-458-5172
Mailing address:
  • Phone: 928-458-5679
  • Fax: 928-458-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: