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Individual

TERRANCE R MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1000 HIGHWAY 12, HETTINGER, ND 58639
(701) 567-4561
Mailing address
1100 HIGHWAY 12, HETTINGER, ND 58639-7533
(701) 567-6130

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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