Individual
CORRENA L TERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K6726
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143155307
—
TX
05
—
143155308
—
TX
01
—
8BQ333
BLUE CROSS/BLUE SHIELD
TX
05
—
94374031
—
NM
Enumeration date
06/02/2006
Last updated
01/08/2018
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