Individual
MR. TERRY A. GANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1670 SOUTH BLVD STE 101A, BARABOO, WI 53913-2944
(608) 995-2847
(844) 689-3562
Mailing address
N4993 6TH DR, WESTFIELD, WI 53964-8200
(608) 296-2121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004565
IL
363A00000X
Physician Assistant
2500-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-004565
STATE LICENSE
IL
01
—
2500-23
WI LICENSE
WI
Enumeration date
09/09/2009
Last updated
02/17/2026
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