Provider Demographics
NPI:1558470864
Name:ESKA, TERRY FULLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:FULLER
Last Name:ESKA
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:PO BOX 1837
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-1337
Mailing Address - Country:US
Mailing Address - Phone:830-672-4995
Mailing Address - Fax:
Practice Address - Street 1:1605 N SARAH DEWITT DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-2700
Practice Address - Country:US
Practice Address - Phone:830-672-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AN27OtherBLUE CROSS
TX09739432Other097394302
TXB22563Medicare UPIN
TX09739432Other097394302