MEDICARE: TERRANCE D DWAYNE GILES JR.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1184455008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE D DWAYNE GILES JR.

Provider Business Mailing Address
First Line	:	201 S HEIGHTS BLVD APT 1113
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5855
Country	:	US
Telephone Number	:	318-278-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S HEIGHTS BLVD APT 1113
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5855
Country	:	US
Telephone Number	:	318-278-7407
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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