Provider Demographics
NPI:1528185998
Name:DAVID W. TERRY
Entity Type:Organization
Organization Name:DAVID W. TERRY
Other - Org Name:WINGATE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-254-9873
Mailing Address - Street 1:1300 N 7TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3062
Mailing Address - Country:US
Mailing Address - Phone:970-254-9873
Mailing Address - Fax:970-254-9880
Practice Address - Street 1:1300 N 7TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3062
Practice Address - Country:US
Practice Address - Phone:970-254-9873
Practice Address - Fax:970-254-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233584Medicaid
CO456288Medicare ID - Type Unspecified
CO01233584Medicaid
COE27271Medicare UPIN