Provider Demographics
NPI:1598741480
Name:UNRUH, TERRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:UNRUH
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 1:4222 WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5915
Mailing Address - Country:US
Mailing Address - Phone:432-550-4200
Mailing Address - Fax:
Practice Address - Street 1:4222 WENDOVER AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5945
Practice Address - Country:US
Practice Address - Phone:432-550-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKG7733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist