Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E10000086 | DE |
Y | 222Z00000X | Podiatrist | E10000086 | DE |
NPI | 1043210917 |
---|---|
Provider Name | Dr. Alexander Terris |
First Address | Wilmington, DE 19810-3719 |
Second Address | Wilmington, DE 19810-3724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000042617 | (05) | DE |
0000600450 | (05) | DE |
1043210917 | NPI (01) | DE |
T27142 | (02) | DE |