Healthcare Provider Details

I. General information

NPI: 1871801282
Provider Name (Legal Business Name): DAVID TERWILLIGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HOSPITAL RD SUITE A
WHITESBURG KY
41858
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-2255
  • Fax: 606-633-3542
Mailing address:
  • Phone: 239-424-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS12044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: