Individual
DR. RUSSELL STEVENS TERRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1549 GALE LEMERAND DR FL 3, GAINESVILLE, FL 32610-0247
(352) 265-8240
(352) 273-7515
Mailing address
1600 SW ARCHER RD # 100247, GAINESVILLE, FL 32610-3003
(352) 273-7608
(352) 273-7515
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
19114
FL
208800000X
Urology Physician
2018-00793
NC
208800000X
Urology Physician
Primary
ME146285
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME146285
FLORIDA BOARD OF MEDICINE
FL
01
—
TRN# 19114
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
06/17/2013
Last updated
08/03/2021
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