Provider Demographics
NPI:1972508570
Name:KILGORE, TERRY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:KILGORE
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 1:2850 LEWIS LN
Mailing Address - Street 2:STE 105
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9383
Mailing Address - Country:US
Mailing Address - Phone:903-785-8488
Mailing Address - Fax:903-785-8031
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:STE 105
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9383
Practice Address - Country:US
Practice Address - Phone:903-785-8486
Practice Address - Fax:903-785-8031
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF8919207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOTK44OtherBLUE CROSS BLUE SHIELD
OK100223450AMedicaid
TX100247902Medicaid
TX100247902Medicaid
TX00TK44Medicare PIN
OK100223450AMedicaid