Provider Demographics
NPI:1255465464
Name:DEVER, TERENCE MICHAEL
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:MICHAEL
Last Name:DEVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LINCOLN ST.
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-781-3535
Mailing Address - Fax:805-503-6499
Practice Address - Street 1:3765 S. HIGUERA
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-781-3535
Practice Address - Fax:805-503-6499
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
390200000XOtherTAXONOMY