Healthcare Provider Details

I. General information

NPI: 1609914712
Provider Name (Legal Business Name): CRYSTAL D. TERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE
ALAMEDA CA
94501-4320
US

IV. Provider business mailing address

2070 CLINTON AVE
ALAMEDA CA
94501-4320
US

V. Phone/Fax

Practice location:
  • Phone: 510-910-1081
  • Fax: 510-814-4090
Mailing address:
  • Phone: 510-910-1081
  • Fax: 510-814-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG56047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: