Provider Demographics
NPI:1528185972
Name:TERRY, DAVID W (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:TERRY
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 1:603 281/4 RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506
Mailing Address - Country:US
Mailing Address - Phone:970-263-2600
Mailing Address - Fax:970-263-2692
Practice Address - Street 1:603 28 1/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-6019
Practice Address - Country:US
Practice Address - Phone:970-263-2600
Practice Address - Fax:970-263-2692
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233584Medicaid
CO456288Medicare ID - Type Unspecified
CO01233584Medicaid