Provider Demographics
NPI:1841229168
Name:TERRY, RICHARD W (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:TERRY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2855 MITCHELL DR
Mailing Address - Street 2:#223
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1600
Mailing Address - Country:US
Mailing Address - Phone:510-452-1345
Mailing Address - Fax:510-452-1102
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:#201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3107
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:510-452-1102
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-06-25
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Provider Licenses
StateLicense IDTaxonomies
CAA24143207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23834Medicare UPIN