Provider Demographics
NPI:1528178902
Name:GERBER, TERRY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:GERBER
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 1:204 E CROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4130
Mailing Address - Country:US
Mailing Address - Phone:903-934-8503
Mailing Address - Fax:877-991-5487
Practice Address - Street 1:204 E CROCKETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4130
Practice Address - Country:US
Practice Address - Phone:903-934-8503
Practice Address - Fax:877-991-5487
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA304703207RC0000X
AL36543207RC0000X
TXL8696207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1701211Medicaid