Provider Demographics
NPI:1629028410
Name:ALEXANDER, TERENCE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:ANTHONY
Last Name:ALEXANDER
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 271429
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1429
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:10450 W MCDOWELL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4901
Practice Address - Country:US
Practice Address - Phone:623-846-7614
Practice Address - Fax:623-846-0993
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27628207XX0005X
WI29782207XX0005X
AZ51325207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0064337Medicaid
E41828Medicare UPIN
E41828Medicare UPIN