Individual
MAX L TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2110 AIRWAY AVE, KINGMAN, AZ 86409-3652
(928) 681-1800
(928) 681-1832
Mailing address
2110 AIRWAY AVE, KINGMAN, AZ 86409-3652
(928) 681-1800
(928) 681-1832
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
31475
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842501
—
AZ
01
—
AZ0749420
BLUE SHIELD ARIZONA
AZ
Enumeration date
06/08/2006
Last updated
03/28/2008
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