Healthcare Provider Details

I. General information

NPI: 1336566579
Provider Name (Legal Business Name): TERRY LI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROUND ROCK AVE
ROUND ROCK TX
78681-4004
US

IV. Provider business mailing address

2600 ESPERANZA XING UNIT 4109
AUSTIN TX
78758-2112
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number312511
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60726358
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA148543
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16944
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR8597
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number181553
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: