Provider Demographics
NPI:1316359789
Name:BANG, TERRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:BANG
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-399-6169
Mailing Address - Fax:601-399-6281
Practice Address - Street 1:1002 JEFFERSON ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4306
Practice Address - Country:US
Practice Address - Phone:601-649-3520
Practice Address - Fax:601-649-7899
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS24870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program