Doctor Name: | DR. JASON BRADLEY TERRELL |
NPI Number: | 1619160686 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | N6065 |
Business Practice Address: | 3513 158th St Lubbock, TX - 794236361 |
Business Phone Number: | 8065439656 |
Business Fax Number: | |
Mailing Address: | 3513 158th St, LUBBOCK |
State: | TX |
Postal Code: | 794236361 |
Phone Number: | 8065439656 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2007 |
NPI Last Update Date: | 10/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | N6065 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |