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NPI Code Detail

MEDICARE: MR. TERENCE PATRICK NETZEL II PA-C

MEDICARE: MR. TERENCE PATRICK NETZEL II PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1164940037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TERENCE PATRICK NETZEL II PA-C
Provider Business Mailing Address
First Line : 2245 S LAUDERDALE ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38106-7517
Country : US
Telephone Number : 901-948-5558
Fax Number : 901-774-9031
Provider Business Practice Location Address
First Line : 2245 S LAUDERDALE ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38106-7517
Country : US
Telephone Number : 901-948-5558
Fax Number : 901-774-9031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2017
Last Update Date : 07/21/2022

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