Provider Demographics
NPI:1609873678
Name:BOUNDS, TERRELL B (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:B
Last Name:BOUNDS
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 1:14540 CORTEZ BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6056
Mailing Address - Country:US
Mailing Address - Phone:352-596-7222
Mailing Address - Fax:352-596-7030
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6056
Practice Address - Country:US
Practice Address - Phone:352-596-7222
Practice Address - Fax:352-596-7030
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-05-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME0023458207X00000X
NC39550207X00000X
CO18308207X00000X
CAG20279207X00000X
AL00017064207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA40884Medicare UPIN
FL17879AMedicare PIN