Provider Demographics
NPI:1679527097
Name:TERPENNING, BUCKLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:BUCKLEY
Middle Name:J
Last Name:TERPENNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2545
Mailing Address - Country:US
Mailing Address - Phone:337-289-2180
Mailing Address - Fax:337-289-2677
Practice Address - Street 1:611 SAINT LANDRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4627
Practice Address - Country:US
Practice Address - Phone:337-289-2180
Practice Address - Fax:337-289-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15160R2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1163741Medicaid
LAF29449Medicare UPIN
LA1163741Medicaid