Provider Demographics
NPI:1003866286
Name:GREWE, TERENCE E (DO)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:E
Last Name:GREWE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3316 E 21ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1967
Mailing Address - Country:US
Mailing Address - Phone:918-749-3533
Mailing Address - Fax:918-749-9789
Practice Address - Street 1:3316 E 21ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1967
Practice Address - Country:US
Practice Address - Phone:918-749-3533
Practice Address - Fax:918-749-9789
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
400522226OtherMEDICARE GROUP NUMBER
OK100746500AOtherMEDICAID GROUP NUMBEF
1073658092OtherNPI GROUP NUMBER
OK100228760AMedicaid
1073658092OtherNPI GROUP NUMBER