Provider Demographics
NPI:1447417324
Name:PEXTON, TERRY (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PEXTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4208
Mailing Address - Country:US
Mailing Address - Phone:360-415-9110
Mailing Address - Fax:360-479-0265
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:STE 200
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4208
Practice Address - Country:US
Practice Address - Phone:360-415-9110
Practice Address - Fax:360-479-0265
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60339103207LP2900X
CA20A 10774207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0312161OtherLABOR & INDUSTRIES
WA0312161OtherLABOR & INDUSTRIES