=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629258843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREG TERRY, M.D.,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2007
-----------------------------------------------------
Last Update Date | 11/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 GARTH RD SUITE 200
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-428-4411
-----------------------------------------------------
Fax | 284-428-4384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 GARTH RD SUITE 200
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-428-4411
-----------------------------------------------------
Fax | 284-428-4384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. GREG TERRY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-428-4411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | H0887
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------