Terry, Mark A

Terry, Mark A is an individual health care provider with primary practice located at 415 6Th St , Lewiston ID 83501-2431. He recently has only one registered license in Allopathic & Osteopathic Physicians / Radiological Physics, which is considered as his primary health care specialty. Terry, Mark A can be contacted via phone (208) 799-5335.

Contact Information

Primary practice address
415 6Th St Lewiston ID 83501-2431
Phone: (208) 799-5335
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Radiological Physics 2085R0205X MD00017547 Washington

Profile Details

NPI number 1649228446
LBN Legal business name Terry, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Nov 5th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649228446 NPPES
Washington Other 0227614 DLI
Washington Other P00468202 DLI
Washington MEDICAID 8255408 DLI
Washington MEDICAID 003973900 DLI
Washington Other 77142 DLI
Washington Other 000010165165 DLI

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