Provider Demographics
NPI:1194817213
Name:TERSCHLUSE, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:TERSCHLUSE
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 1:11373 CORTEZ BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5411
Mailing Address - Country:US
Mailing Address - Phone:352-596-0744
Mailing Address - Fax:352-596-5401
Practice Address - Street 1:11373 CORTEZ BLVD STE 301
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5411
Practice Address - Country:US
Practice Address - Phone:352-596-0744
Practice Address - Fax:352-596-5401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R7B83208600000X
FLME 122305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO020005962OtherRAILROAD MEDICARE
MO020005962OtherRAILROAD MEDICARE
MO018925613Medicare PIN