Provider Demographics
NPI:1518178938
Name:TERRY, JULIAN ANTHONY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ANTHONY
Last Name:TERRY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8850
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0015
Mailing Address - Country:US
Mailing Address - Phone:479-521-4433
Mailing Address - Fax:479-521-0444
Practice Address - Street 1:3215 N NORTHHILLS BLVD
Practice Address - Street 2:STE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4424
Practice Address - Country:US
Practice Address - Phone:479-521-4433
Practice Address - Fax:479-521-0444
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6983207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188110001Medicaid
AR188110001Medicaid