MEDICARE: DR. TERRY LEE MCDERMOTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N0261	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AN557	OTHER	TX	BCBSTX
3	198535002	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1093976219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY LEE MCDERMOTT M.D.

Provider Business Mailing Address
First Line	:	5503 FRY RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-5845
Country	:	US
Telephone Number	:	713-873-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	5503 FRY RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-5845
Country	:	US
Telephone Number	:	713-873-6860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	11/02/2023

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