Healthcare Provider Details

I. General information

NPI: 1003366485
Provider Name (Legal Business Name): TERRELL OB/GYN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TEJAS DR
TERRELL TX
75160-6676
US

IV. Provider business mailing address

PO BOX 8115
GREENVILLE TX
75404-8115
US

V. Phone/Fax

Practice location:
  • Phone: 903-454-2130
  • Fax: 903-454-5487
Mailing address:
  • Phone: 903-454-2130
  • Fax: 903-454-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. DWON BLEVINS
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 903-454-2130