Provider Demographics
NPI:1669457321
Name:PUSTILNIK, TERRI BAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:BAILEY
Last Name:PUSTILNIK
Suffix:
Gender:F
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:501 W MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4219
Practice Address - Country:US
Practice Address - Phone:281-332-7505
Practice Address - Fax:281-332-7616
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3406207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX980000035OtherMEDICARE RAILROAD
TX041371806Medicaid
TX041371804Medicaid
TX041371802Medicaid
TXP00930575OtherRAILROAD MEDICARE
TXTXB120047Medicare PIN
TX041371802Medicaid
TX980000035OtherMEDICARE RAILROAD