MEDICARE: DR. HOLLY ELAINE TIMMONS TERRY 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	7900166-1205	UT

General Provider Information

NPI Number	:	1932366820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY ELAINE TIMMONS TERRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 W STATE ROAD 73
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-2901
Country	:	US
Telephone Number	:	801-341-5200
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	10/15/2013

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