Provider Demographics
NPI:1710959762
Name:PEERY, TERRY SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:SCOTT
Last Name:PEERY
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 1:16040 PARK VALLEY DRIVE,
Mailing Address - Street 2:BLDG B-100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-218-1222
Mailing Address - Fax:512-218-1393
Practice Address - Street 1:16040 PARK VALLEY DRIVE,
Practice Address - Street 2:BLDG B-100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-218-1222
Practice Address - Fax:512-218-1393
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM54362084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTIN PLUS 095OtherTRICARE
TXTIN PLUS 115OtherTRICARE
TXTIN PLUS 015OtherTRICARE TC JV LOCATION
TX197905602Medicaid
TX8BC075OtherBCBS
TXTIN PLUS 052OtherTRICARE
TX197905601Medicaid
TXTIN PLUS 115OtherTRICARE
TXTIN PLUS 015OtherTRICARE TC JV LOCATION