Healthcare Provider Details

I. General information

NPI: 1821078858
Provider Name (Legal Business Name): JAMES WAYNE TERBUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 GARDEN OF THE GODS RD SUITE 2044
COLORADO SPRINGS CO
80907-9444
US

IV. Provider business mailing address

1675 GARDEN OF THE GODS RD SUITE 2044
COLORADO SPRINGS CO
80907-9444
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-3258
  • Fax: 719-575-8664
Mailing address:
  • Phone: 719-578-3258
  • Fax: 719-575-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24102
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: