Healthcare Provider Details

I. General information

NPI: 1679527097
Provider Name (Legal Business Name): BUCKLEY J TERPENNING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SAINT LANDRY ST
LAFAYETTE LA
70506-4627
US

IV. Provider business mailing address

PO BOX 52545
LAFAYETTE LA
70505-2545
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-2180
  • Fax: 337-289-2677
Mailing address:
  • Phone: 337-289-2180
  • Fax: 337-289-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number15160R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15160R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: