Provider Demographics
NPI:1730102625
Name:HEBERT, TERRELL KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:KENT
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-9383
Mailing Address - Country:US
Mailing Address - Phone:231-725-4105
Mailing Address - Fax:
Practice Address - Street 1:165 E APPLE AVE
Practice Address - Street 2:STE 201
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3463
Practice Address - Country:US
Practice Address - Phone:231-725-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20758207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine