Provider Demographics
NPI:1518071653
Name:MADSEN, TERRY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DOUGLAS
Last Name:MADSEN
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 1:3009 E RENNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3571
Mailing Address - Country:US
Mailing Address - Phone:972-664-0606
Mailing Address - Fax:972-664-0808
Practice Address - Street 1:3009 E RENNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3571
Practice Address - Country:US
Practice Address - Phone:972-664-0606
Practice Address - Fax:972-664-0808
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8816207X00000X
OH35083939M207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171293701Medicaid
TX171291101Medicaid
TX00386XMedicare PIN
TXI18398Medicare UPIN
TX171291101Medicaid
TX171293701Medicaid
TX8C6131Medicare PIN