Provider Demographics
NPI:1104195916
Name:AHERN, TERENCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:L
Last Name:AHERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 RED DOG RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9564
Mailing Address - Country:US
Mailing Address - Phone:206-850-5261
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-727-8800
Practice Address - Fax:208-727-8124
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-13191207P00000X
ORMD170843207P00000X
CAA123764207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine