Provider Demographics
NPI:1023579927
Name:PRASAD, TERRENCE ANIL (DO)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:ANIL
Last Name:PRASAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13943 N 91ST AVE STE I
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3692
Mailing Address - Country:US
Mailing Address - Phone:623-815-2690
Mailing Address - Fax:623-815-2689
Practice Address - Street 1:13943 N 91ST AVE STE I
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3692
Practice Address - Country:US
Practice Address - Phone:623-815-2690
Practice Address - Fax:623-815-2689
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022025164207RR0500X
390200000X
AZ011020207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program