Provider Demographics
NPI:1275721045
Name:TERRY GAGE, MD
Entity Type:Organization
Organization Name:TERRY GAGE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-793-5683
Mailing Address - Street 1:4102 24TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1806
Mailing Address - Country:US
Mailing Address - Phone:806-793-5683
Mailing Address - Fax:806-793-3821
Practice Address - Street 1:4102 24TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1806
Practice Address - Country:US
Practice Address - Phone:806-793-5683
Practice Address - Fax:806-793-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005QVOtherBLUECROSS BLUESHIELD
TX111493604Medicaid
TX111493604Medicaid
TXC15837Medicare UPIN