Provider Demographics
NPI:1427168764
Name:BABB, TERRENCE ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ELLIOTT
Last Name:BABB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2497
Mailing Address - Country:US
Mailing Address - Phone:605-697-9500
Mailing Address - Fax:605-697-6939
Practice Address - Street 1:400 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2497
Practice Address - Country:US
Practice Address - Phone:605-697-9500
Practice Address - Fax:605-697-6939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036379E207Q00000X, 207V00000X
SDLT1049207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1128370Medicaid
SD6201512Medicaid
PA174918Medicare ID - Type Unspecified
PAB40677Medicare UPIN
SD102542Medicare PIN