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Individual
TERRANCE R MACK
Active
Individual
TERRANCE R MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3393
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0553685
—
IA
01
—
10777
ND BLUE CROSS
—
01
—
123993
WORKERS COMP
—
05
—
12565
—
ND
01
—
27025
SIOUX VALLEY
—
05
—
45034068812
—
NE
01
—
4999831
SD WELLMARK
—
05
—
7776040
—
SD
Enumeration date
10/02/2006
Last updated
07/08/2007
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