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General NPI Number Information
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NPI Number | 1528391539
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Entity Type | Individual
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Provider Name | TERRY A. GANDER PA
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Gender | Male
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 1670 SOUTH BLVD STE 101A
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City | BARABOO
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State | WI
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Zip | 53913-2944
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Country | US
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Telephone | 608-995-2847
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Fax | 844-689-3562
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Provider Business Mailing Address
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Address Line | N4993 6TH DR
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City | WESTFIELD
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State | WI
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Zip | 53964-8200
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Country | US
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Telephone | 608-296-2121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2500-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-004565
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License Number State | IL
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