Provider Demographics
NPI:1871504969
Name:MCANALLEN, TERRY JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JOSEPH
Last Name:MCANALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:T.J.
Other - Middle Name:
Other - Last Name:MCANALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:595 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7015
Practice Address - Country:US
Practice Address - Phone:702-566-5500
Practice Address - Fax:702-558-7238
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1484207Q00000X
NVDO1484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO1484OtherSTATE LICENSE
NV1871504969Medicaid
H92284Medicare UPIN