Provider Demographics
NPI:1326565813
Name:TERRELL, ALFRED LEE
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LEE
Last Name:TERRELL
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 1:928 NORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2278
Mailing Address - Country:US
Mailing Address - Phone:214-701-9706
Mailing Address - Fax:972-863-7394
Practice Address - Street 1:928 NORWOOD LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-2278
Practice Address - Country:US
Practice Address - Phone:214-701-9706
Practice Address - Fax:972-863-7394
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)