Provider Demographics
NPI:1235142985
Name:BOX, TERRY D (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:BOX
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 1:1779 MILL LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3221
Mailing Address - Country:US
Mailing Address - Phone:801-277-8254
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:4R118 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-6923
Practice Address - Country:US
Practice Address - Phone:801-581-7804
Practice Address - Fax:801-581-7476
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163791-1205207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005532203Medicare ID - Type UnspecifiedMEDICARE NUMBER
UTC63587Medicare UPIN