Provider Demographics
NPI:1578612842
Name:TERRENCE R DWYRE MD INC
Entity Type:Organization
Organization Name:TERRENCE R DWYRE MD INC
Other - Org Name:TERRENCE R DWYRE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DWYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-226-5465
Mailing Address - Street 1:393 BLOSSOM HILL ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1652
Mailing Address - Country:US
Mailing Address - Phone:408-226-5465
Mailing Address - Fax:408-226-5466
Practice Address - Street 1:393 BLOSSOM HILL ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1652
Practice Address - Country:US
Practice Address - Phone:408-226-5465
Practice Address - Fax:408-226-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44117Medicare UPIN