Healthcare Provider Details

I. General information

NPI: 1902008360
Provider Name (Legal Business Name): MR. TERRY LEE PARTHEMORE II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 THOMPSON RD
COOS BAY OR
97420
US

IV. Provider business mailing address

1775 THOMPSON RD
COOS BAY OR
97420-2198
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3400
  • Fax:
Mailing address:
  • Phone: 707-423-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number095000604RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: