Provider Demographics
NPI:1790739019
Name:GERARD, TERRY R II (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:GERARD
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1400 BRYAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2157
Mailing Address - Country:US
Mailing Address - Phone:580-924-5500
Mailing Address - Fax:580-924-1991
Practice Address - Street 1:1400 BRYAN DR STE 201
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2157
Practice Address - Country:US
Practice Address - Phone:580-924-5500
Practice Address - Fax:580-924-1991
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4190207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E46835Medicare UPIN