Provider Demographics
NPI:1396772182
Name:MILLS, TERRY L (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:MILLS
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 1:7333 E 121ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2654
Mailing Address - Country:US
Mailing Address - Phone:918-403-7140
Mailing Address - Fax:918-856-5392
Practice Address - Street 1:7333 E 121ST ST S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2654
Practice Address - Country:US
Practice Address - Phone:918-403-7140
Practice Address - Fax:918-856-5392
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS28118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS16999OtherCOVENTRY
KS12149401OtherMULTIPLAN
KS055782OtherBCBS
KS11852OtherPHS
KS100260OtherHPK
KS100339130AMedicaid
KS11852OtherPHS