Terry L. Pangburn
Individual provider Active NPI Driver · Moulton, IA
NPI 1164693545 · NPPES record last updated Mar 13, 2008
Key facts
- NPI
- 1164693545
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 022AA0001 (IA)
- Practice address
- 109 S Elm St
Moulton, IA 52572-1441 - Phone
- (641) 856-7734
- NPI assigned
- Mar 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022AA0001 | IA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 022AA0001 | IA | Yes |
Addresses
Primary practice location
109 S Elm St
Moulton, IA 52572-1441
Mailing address
109 S Elm St
Moulton, IA 52572-1441
Phone (641) 856-7734
Other providers in Moulton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.