Provider Demographics
NPI:1376585406
Name:TERRASSON, EDWARD L (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:L
Last Name:TERRASSON
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 1:18230 FM 1488 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4530
Mailing Address - Country:US
Mailing Address - Phone:936-270-4800
Mailing Address - Fax:
Practice Address - Street 1:18230 FM 1488 RD STE 200
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354
Practice Address - Country:US
Practice Address - Phone:936-270-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177778101Medicaid
TX177778104Medicaid
8A0572Medicare ID - Type Unspecified