Provider Demographics
NPI:1972501773
Name:TERRY, GREGORY M (MD,)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N ALEXANDER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3368
Mailing Address - Country:US
Mailing Address - Phone:281-428-4411
Mailing Address - Fax:281-428-4384
Practice Address - Street 1:2610 N ALEXANDER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3368
Practice Address - Country:US
Practice Address - Phone:281-428-4411
Practice Address - Fax:281-428-4384
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR000OtherBLUE CROSS BLUE SHIELD
TX158508501Medicaid
TXP01337849OtherRR MEDICARE
TX0045KCOtherBLUE CROSS
TX133475709Medicaid
TXP00937540OtherMEDICARE RR
TX133475710Medicaid
TX1972501773OtherBLUE CROSS BLUE SHIELD
TXB26926Medicare UPIN
TX332239ZSWDMedicare PIN
TX133475709Medicaid
TX0045KCOtherBLUE CROSS
TX158508501Medicaid