Provider Demographics
NPI:1356349195
Name:STELLY, TERRY CHRIS (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:CHRIS
Last Name:STELLY
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:OUR LADY OF THE LAKE PHYSICIAN GROUP CARDIOTHORACIC SUR
Practice Address - Street 2:7777 HENNESSY BOULEVARD SUITE 8001
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-490-7224
Practice Address - Fax:225-490-7223
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320795208G00000X
AL00015345208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-26638OtherBLUE CROSS BLUE SHIELD
AL000026638Medicaid
AL000026638Medicare PIN
AL510-26638OtherBLUE CROSS BLUE SHIELD