Provider Demographics
NPI:1881992121
Name:DOOLEY, TERRENCE EDWARD II (PA-C)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:EDWARD
Last Name:DOOLEY
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 WOODSTEAD CT
Mailing Address - Street 2:STE 300
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-367-0400
Mailing Address - Fax:281-367-1201
Practice Address - Street 1:1441 WOODSTEAD CT
Practice Address - Street 2:STE 300
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-367-0400
Practice Address - Fax:281-367-1201
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001268A363AS0400X
TXPA08553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400047579Medicare PIN
IN0449980001Medicare NSC