Provider Demographics
NPI:1003947128
Name:HOWARD, TERRY (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0278
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:1206 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2455
Practice Address - Country:US
Practice Address - Phone:423-884-7271
Practice Address - Fax:423-884-3277
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2423207Q00000X
MODO105391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4343153OtherBCBS OF TN
TNQ000117Medicaid
MO246965412Medicaid
TNP01133007OtherMEDICARE RR
10851741OtherCAQH
TN103I126063Medicare PIN
TNP01133007OtherMEDICARE RR