Provider Demographics
NPI:1649281940
Name:TERPSTRA, GREGORY DEAN (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:TERPSTRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0308
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:305 RIVER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7801
Practice Address - Country:US
Practice Address - Phone:423-334-4154
Practice Address - Fax:423-334-4195
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33040201Medicare PIN
441818Medicare Oscar/Certification