Provider Demographics
NPI:1770769309
Name:MARK A. TERRY, M.D., P.C.
Entity type:Organization
Organization Name:MARK A. TERRY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-413-6223
Mailing Address - Street 1:204 SE STONE MILL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3544
Mailing Address - Country:US
Mailing Address - Phone:360-514-9060
Mailing Address - Fax:360-514-9041
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE N200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17016261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center