Provider Demographics
NPI:1417921008
Name:TERRY, STACY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:TERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 LEGACY DR.
Mailing Address - Street 2:201
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5128
Mailing Address - Country:US
Mailing Address - Phone:972-668-6705
Mailing Address - Fax:972-668-7308
Practice Address - Street 1:4040 LEGACY DR.
Practice Address - Street 2:201
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-668-6705
Practice Address - Fax:972-668-7308
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003LBOtherBCBS
TX162238301Medicaid