Provider Demographics
NPI:1114901758
Name:BURRIS, TERRY EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:EUGENE
Last Name:BURRIS
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 1:6950 SW HAMPTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8329
Mailing Address - Country:US
Mailing Address - Phone:503-624-4814
Mailing Address - Fax:503-624-4904
Practice Address - Street 1:6950 SW HAMPTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8329
Practice Address - Country:US
Practice Address - Phone:503-624-4814
Practice Address - Fax:503-624-4904
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14736207W00000X, 207WX0108X
WA37155207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101394Medicaid
OR080030000OtherREGENCE BLUE CROSS
OR2729230OtherCIGNA INSURANCE
ORC90918OtherPROVIDENCE
ORC90918OtherPROVIDENCE
OR0004BHVMNMedicare PIN