Provider Demographics
NPI:1740287325
Name:PASSMAN, TERRY ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ELLIOT
Last Name:PASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:208 GREENO RD N STE D2
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3057
Mailing Address - Country:US
Mailing Address - Phone:251-928-4750
Mailing Address - Fax:251-990-2560
Practice Address - Street 1:208 GREENO RD N STE D2
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3057
Practice Address - Country:US
Practice Address - Phone:251-928-4750
Practice Address - Fax:251-990-2560
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL184682084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000077486Medicaid
AL51077486OtherBIC