Healthcare Provider Details

I. General information

NPI: 1447257415
Provider Name (Legal Business Name): RAY B TERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 FALCON DR STE G03
MT STERLING KY
40353-9792
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-497-5580
  • Fax: 859-497-5581
Mailing address:
  • Phone: 606-330-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01090003A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32768
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: