Provider Demographics
NPI:1942246913
Name:WILLIAMS, TERENCE DALE (PA)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:DALE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:16928 W BELL RD # S701
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8948
Mailing Address - Country:US
Mailing Address - Phone:602-635-6941
Mailing Address - Fax:602-635-6952
Practice Address - Street 1:12361 W BOLA DR STE 109
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:623-227-1000
Practice Address - Fax:623-227-2000
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2025-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ6352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970001480Medicare PIN
CTP00083093Medicare PIN
P99218Medicare UPIN