Healthcare Provider Details

I. General information

NPI: 1750568168
Provider Name (Legal Business Name): MICHAEL JAMES TERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE SUITE M-593
SAN FRANCISCO CA
94143-0628
US

IV. Provider business mailing address

505 PARNASSUS AVE SUITE M-593
SAN FRANCISCO CA
94143-0628
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4285
  • Fax:
Mailing address:
  • Phone: 415-353-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA126844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA126844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: