MEDICARE: TERRY L THRASHER D.O.

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	208D00000X	General Practice Physician	106165	MO
2	207Q00000X	Family Medicine Physician	106165	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106165	OTHER	MO	MEDICAL LICENSE

General Provider Information

NPI Number	:	1962492223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY L THRASHER D.O.

Provider Business Mailing Address
First Line	:	413 W 2ND ST
Second Line	:
City	:	SALISBURY
State	:	MO
Zip	:	65281-1405
Country	:	US
Telephone Number	:	660-388-7084
Fax Number	:	660-388-7087

Provider Business Practice Location Address
First Line	:	2101 CORONA RD STE 102
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2582
Country	:	US
Telephone Number	:	573-234-1800
Fax Number	:	573-234-1799

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	11/20/2023

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