Provider Demographics
NPI:1326049438
Name:VENDEN, TERRANCE D (PA, C)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:D
Last Name:VENDEN
Suffix:
Gender:M
Credentials:PA, C
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 1325
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1325
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4130
Practice Address - Street 1:815 S WASHINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5369
Practice Address - Country:US
Practice Address - Phone:903-927-6800
Practice Address - Fax:903-935-0617
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83N021Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
TXS-90407Medicare UPIN