Provider Demographics
NPI:1639183320
Name:GUILEY, TERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:GUILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HEALTH WAY DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1434
Mailing Address - Country:US
Mailing Address - Phone:573-438-2977
Mailing Address - Fax:573-438-8787
Practice Address - Street 1:1 KWAN PLZ
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1435
Practice Address - Country:US
Practice Address - Phone:573-438-0751
Practice Address - Fax:573-438-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR80142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240009324Medicaid
MOA10387Medicare ID - Type Unspecified