Provider Demographics
NPI:1881636439
Name:CARRON, TERRI L (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:CARRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857B LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2058
Mailing Address - Country:US
Mailing Address - Phone:314-682-3626
Mailing Address - Fax:314-590-5933
Practice Address - Street 1:8857B LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2058
Practice Address - Country:US
Practice Address - Phone:314-682-3626
Practice Address - Fax:314-590-5933
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1062JOtherBC/BS NC PROVIDER#
NCFH1000050OtherFIRSTCAROLINACARE PROV.#
NC891062JMedicaid
SCN00888OtherSC MEDICAID PROVIDER#
NC80112OtherMEDCOST PROVIDER#
NC110150793OtherPALMETTO GBA PROVIDER#
NC0403889OtherEVERCARE
NCFH1000050OtherFIRSTCAROLINACARE PROV.#
NC891062JMedicaid