Provider Demographics
NPI:1710016399
Name:M. TERRY BURKHALTER, MD, PC
Entity Type:Organization
Organization Name:M. TERRY BURKHALTER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-4015
Mailing Address - Street 1:1800 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2206
Mailing Address - Country:US
Mailing Address - Phone:615-327-4015
Mailing Address - Fax:615-327-4080
Practice Address - Street 1:1800 STATE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2206
Practice Address - Country:US
Practice Address - Phone:615-327-4015
Practice Address - Fax:615-327-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004401OtherBLUE CROSS
TN3162943Medicare ID - Type Unspecified
TNB02973Medicare UPIN
TN3718779Medicare ID - Type UnspecifiedGROUP PROVIDER