Healthcare Provider Details

I. General information

NPI: 1144275009
Provider Name (Legal Business Name): TERRY STEVE MCCUISTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 POPLAR ST
MURRAY KY
42071-2432
US

IV. Provider business mailing address

1160 A B LASSITER RD
MURRAY KY
42071-4856
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29665
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: