Provider Demographics
NPI:1700225380
Name:TERRY, RUSSELL STEVENS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:STEVENS
Last Name:TERRY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 SW ARCHER RD # 100247
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-273-7608
Mailing Address - Fax:352-273-7515
Practice Address - Street 1:1549 GALE LEMERAND DR FL 3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0247
Practice Address - Country:US
Practice Address - Phone:352-265-8240
Practice Address - Fax:352-273-7515
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2021-08-03
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Provider Licenses
StateLicense IDTaxonomies
FL19114208800000X
NC2018-00793208800000X
FLME146285208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN# 19114OtherFLORIDA DEPARTMENT OF HEALTH
FLME146285OtherFLORIDA BOARD OF MEDICINE