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Individual
WAYNE TERIS
Active
Individual
WAYNE TERIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
169081
NY
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
169081
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01015214
—
NY
Enumeration date
08/02/2005
Last updated
02/06/2013
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