Provider Demographics
NPI:1487654836
Name:BORING, TERRENCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:H
Last Name:BORING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:530 N MONTE VISTA
Mailing Address - Street 2:SUITE A
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:580-436-7101
Mailing Address - Fax:580-436-4447
Practice Address - Street 1:3101 ARLINGTON
Practice Address - Street 2:SUITE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3085
Practice Address - Country:US
Practice Address - Phone:580-332-9100
Practice Address - Fax:580-332-8554
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100208560AMedicaid
OKC94704Medicare UPIN
OK2112Medicare PIN