Provider Demographics
NPI:1184618837
Name:FORREST, TERRY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:FORREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:103 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9478
Mailing Address - Country:US
Mailing Address - Phone:919-734-8440
Mailing Address - Fax:919-734-9387
Practice Address - Street 1:103 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9478
Practice Address - Country:US
Practice Address - Phone:919-734-8440
Practice Address - Fax:919-734-9387
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27759207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC33094OtherBCBSNC
NC8933094Medicaid
NC8933094Medicaid
NCC83833Medicare UPIN